腹膜恶性肿瘤根治性手术后外科再次干预中开放性腹腔的负压伤口治疗增加复发风险。
Negative-Pressure Wound Therapy for Open Abdomen in Surgical Reintervention after Curative Surgery of Peritoneal Malignancy Increases the Risk of Recurrence.
作者信息
Rabel Thomas, Bonnot Pierre-Emmanuel, Hadeedi Omar, Kepenekian Vahan, Bernard Lorraine, Friggeri Arnaud, Glehen Olivier, Passot Guillaume
机构信息
In the Department of Visceral and Oncologic Surgery, Hospital Lyon Sud, Hospices Civils de Lyon, France, Thomas Rabel, MD, is Resident; Pierre-Emmanuel Bonnot, MD, is Surgical Fellow; Omar Hadeedi, MSc, is Visiting Surgical Fellow; and Vahan Kepenekian, MD, is Surgeon and Faculty. Lorraine Bernard is Biostastistician, Department of Biostatistics, Hospices Civils de Lyon. Arnaud Friggeri, MD, PhD, is Anesthesiologist and Faculty, Department of Anesthesiology and Intensive Care, Hopital Lyon Sud. Also in the Department of Visceral and Oncologic Surgery, Hospital Lyon Sud, Olivier Glehen, MD, PhD, is Surgeon and Head of the Department and Guillaume Passot, MD, PhD, is Surgeon. The authors have disclosed no financial relationships related to this article. Submitted August 17, 2022; accepted in revised form December 9, 2022.
出版信息
Adv Skin Wound Care. 2023 Nov 1;36(11):1-5. doi: 10.1097/ASW.0000000000000018.
OBJECTIVE
Negative-pressure wound therapy for open abdomen (NPWTOA) helps reduce the risk of abdominal compartment syndrome. However, the risk of recurrence of cancer is unclear when NPWTOA is applied after oncologic resection. The aim of this study was to evaluate the effects of NPWTOA used for major complications on patients treated with cytoreductive surgery for peritoneal malignancy (PM).
METHODS
All patients who underwent an NPWTOA after potentially curative surgery of PM in a single institution were included. These patients were pair matched 1:3 on the Peritoneal Cancer Index, completeness of cytoreduction using a scoring index, and PM origin with patients who underwent surgical reintervention without NPWTOA after curative surgery of PM. Survival among the two groups was compared using the Kaplan-Meier method.
RESULTS
Between 2011 and 2017, among 719 curative surgeries for PM, 13 patients underwent an NPWTOA after surgical reintervention. Researchers paired 9 of these patients to 27 others without NPWTOA after surgical reintervention. Median overall survival was 4.8 and 35 months (P = .391), and median disease-free survival was 4.0 and 13.9 months (P = .022) for the NPWTOA and non-NPWTOA groups, respectively.
CONCLUSIONS
The use of the NPWTOA during surgical reintervention after curative surgery for PM may increase the risk of early recurrence.
目的
开放性腹部负压伤口治疗（NPWTOA）有助于降低腹腔间隔室综合征的风险。然而，肿瘤切除术后应用NPWTOA时癌症复发的风险尚不清楚。本研究的目的是评估NPWTOA用于治疗腹膜恶性肿瘤（PM）减瘤手术患者主要并发症的效果。
方法
纳入在单一机构接受PM根治性手术后接受NPWTOA的所有患者。根据腹膜癌指数、使用评分指数评估的减瘤完整性以及PM起源，将这些患者与接受PM根治性手术后未接受NPWTOA而进行手术再次干预的患者按1:3进行配对。采用Kaplan-Meier法比较两组患者的生存率。
结果
2011年至2017年期间，在719例PM根治性手术中，13例患者在手术再次干预后接受了NPWTOA。研究人员将其中9例患者与27例手术再次干预后未接受NPWTOA的患者进行配对。NPWTOA组和非NPWTOA组的中位总生存期分别为4.8个月和35个月（P = 0.391），中位无病生存期分别为4.0个月和13.9个月（P = 0.022）。
结论
PM根治性手术后手术再次干预期间使用NPWTOA可能会增加早期复发的风险。
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