Arjona-Sanchez A, Aziz O, Passot G, Salti G, Serrano A, Esquivel J, Van der Speeten K, Sommariva A, Kazi M, Shariff U, Martínez-Regueira F, Piso P, Yonemura Y, Turaga K, Sgarbura O, Avanish Saklani A, Tonello M, Rodriguez-Ortiz L, Vazquez-Borrego M C, Romero-Ruiz A, Glehen O
Unit of Surgical Oncology, Reina Sofia University Hospital, Cordoba, Spain; GE09 Research in Peritoneal and Retroperitoneal Oncologic Surgery Group. Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofía University Hospital, Department of Biochemistry and Molecular Biology, University of Cordoba, Córdoba, Spain.
Colorectal and Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, UK.
Eur J Surg Oncol. 2023 Oct;49(10):107001. doi: 10.1016/j.ejso.2023.107001. Epub 2023 Aug 3.
The laparoscopic approach for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (L-CRS + HIPEC) in highly selected patients was previously reported from the PSOGI registry with a demonstrable reduction in length of stay and post-operative morbidity. This study aims to update this international PSOGI registry with a larger cohort of patients and a longer follow-up period.
An international registry was designed through a networking database (REDCAP®). All centers performing L-CRS + HIPEC were invited through PSOGI to submit data on their cases. Variables such as demographics, clinical outcomes, and survival were analyzed.
A total of 315 L-CRS + HIPEC cases were provided by 14 worldwide centers. A total of 215 patients were included in the L-CRS + HIPEC group. The median peritoneal cancer index (PCI) was 3 (3-5). The median length of stay was 7 days (5-10) and the major morbidity (Clavien-Dindo ≥3) was 6.1% after 30 days. The 5-year disease-free survival (DFS) per tumor origin was: 94% for PMP-LG, 85% for PMP-HG, 100% for benign multicyst peritoneal mesothelioma (MPM), 37.4% for colonic origin, and 54%(at 3 years) for ovarian origin. The 5 years overall survival (OS) per tumor origin was: 100% for PMP-LG, PMP-HG and MPM; 61% for colonic origin, and 74% (at 3 years) for ovarian origin. In addition, a total of 85 patients were analyzed in the laparoscopic risk-reducing HIPEC (L-RR + HIPEC). The median length of stay was 5 days (4-6) and the major morbidity was 6% after 30 days. The 5-year DFS per tumor origin was: 96% for perforated low grade appendiceal mucinous neoplasm (LAMN II) and 68.1% for colon origin. The 5 years OS per tumor origin was: 98% for LAMN II and 83.5% for colonic origin.
Minimally invasive CRS + HIPEC is a safe procedure for selected patients with peritoneal carcinomatosis in specialized centers. It improves perioperative results while providing satisfactory oncologic outcomes. L-RR + HIPEC represents a promising strategy that could be evaluated in patients with high risk of developing peritoneal carcinomatosis into prospective randomized trials.
先前PSOGI登记处报告了高度选择的患者行腹腔镜减瘤手术及热灌注化疗（L-CRS + HIPEC）的情况，结果显示住院时间和术后发病率明显降低。本研究旨在纳入更多患者队列并延长随访时间，更新这一国际PSOGI登记处的数据。
通过网络数据库（REDCAP®）设计了一个国际登记处。通过PSOGI邀请所有进行L-CRS + HIPEC的中心提交其病例数据。对人口统计学、临床结局和生存率等变量进行分析。
全球14个中心共提供了315例L-CRS + HIPEC病例。L-CRS + HIPEC组共纳入215例患者。腹膜癌指数（PCI）中位数为3（3 - 5）。住院时间中位数为7天（5 - 10天），30天后严重并发症（Clavien-Dindo≥3级）发生率为6.1%。按肿瘤起源划分的5年无病生存率（DFS）为：黏液性交界性肿瘤（PMP-LG）为94%，黏液性高级别肿瘤（PMP-HG）为85%，良性多囊性腹膜间皮瘤（MPM）为100%，结肠起源为37.4%，卵巢起源为54%（3年时）。按肿瘤起源划分的5年总生存率（OS）为：PMP-LG、PMP-HG和MPM为100%；结肠起源为61%，卵巢起源为74%（3年时）。此外，对85例行腹腔镜降低风险热灌注化疗（L-RR + HIPEC）的患者进行了分析。住院时间中位数为5天（4 -
6天），30天后严重并发症发生率为6%。按肿瘤起源划分的5年DFS为：穿孔性低级别阑尾黏液性肿瘤（LAMN II）为96%，结肠起源为68.1%。按肿瘤起源划分的5年OS为：LAMN II为98%，结肠起源为83.5%。
对于专业中心选定的腹膜癌患者，微创CRS + HIPEC是一种安全的手术方式。它改善了围手术期结果，同时提供了令人满意的肿瘤学结局。L-RR + HIPEC是一种有前景的策略，可在前瞻性随机试验中对有发生腹膜癌高风险的患者进行评估。
