Department of General Surgery, Te Whatu Ora Waikato, Hamilton, New Zealand.
School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
ANZ J Surg. 2024 Apr;94(4):621-627. doi: 10.1111/ans.18777. Epub 2023 Nov 22.
Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have improved survival for selected cases of peritoneal surface malignancy. In 2008, a CRS/HIPEC service was first established in Aotearoa New Zealand (AoNZ) at Waikato and Braemar Hospitals in the Waikato region.
This is a retrospective review of a prospectively maintained database of all patients undergoing CRS/HIPEC from 1 January 2008 to 1 November 2020 at Waikato and Braemar Hospitals. We analysed long-term survival and predictors of survival for each tumour type.
240 procedures were performed for 221 patients, including 22 re-do procedures. Cases had a median peritoneal cancer index of 16. Complete cytoreduction (CC0-1) was achieved in 196 cases (81.7%). All complete cytoreduction cases received HIPEC. There were 152 pseudomyxoma peritonei (PMP), 39 colorectal cancers (CRC), 29 appendiceal cancers, eight ovarian cancers, six peritoneal mesotheliomas, and six other cancers. The 5-year overall survival (OS) for PMP with acellular mucin, low-grade mucinous carcinoma peritonei, and high-grade mucinous carcinoma peritonei with or without signet cells were 91.6%, 80.5%, and 72.2%, respectively. 2- and 5-year OS in CRC were 56.7% and 40.4%. The achievement of complete cytoreduction improved the 5-year OS to 87.9% across all PMP and 45.1% in colorectal cancer. Incomplete cytoreduction predicted worse survival in appendiceal PMP. In colorectal cancer, worse survival was predicted in those who had incomplete cytoreduction, liver metastasis, and presentation with obstruction and perforation.
Favourable long-term outcomes following CRS/HIPEC for peritoneal surface malignancy have been achieved in AoNZ through the Waikato peritonectomy service.
细胞减灭术（CRS）和腹腔内热灌注化疗（HIPEC）为选定的腹膜表面恶性肿瘤病例改善了生存。2008 年，在新西兰奥特亚罗瓦（Aotearoa New Zealand，简称 AoNZ）的怀卡托地区的怀卡托和布雷马尔医院首次建立了 CRS/HIPEC 服务。
这是对 2008 年 1 月 1 日至 2020 年 11 月 1 日在怀卡托和布雷马尔医院接受 CRS/HIPEC 的所有患者的前瞻性维护数据库的回顾性分析。我们分析了每种肿瘤类型的长期生存和生存预测因素。
221 名患者共进行了 240 次手术，其中包括 22 次再手术。病例的腹膜癌指数中位数为 16。196 例患者达到完全肿瘤细胞减灭（CC0-1）。所有完全肿瘤细胞减灭病例均接受 HIPEC。有 152 例假性黏液瘤（PMP）、39 例结直肠癌（CRC）、29 例阑尾癌、8 例卵巢癌、6 例腹膜间皮瘤和 6 例其他癌症。无细胞黏液型、低级别黏液性癌腹膜和高级别黏液性癌腹膜伴或不伴印戒细胞的 PMP 的 5 年总生存率（OS）分别为 91.6%、80.5%和 72.2%。CRC 的 2 年和 5 年 OS 分别为 56.7%和 40.4%。完全肿瘤细胞减灭术的疗效提高了所有 PMP 的 5 年 OS 至 87.9%，以及结直肠癌的 5 年 OS 至 45.1%。阑尾 PMP 的不完全肿瘤细胞减灭术预测生存率较差。在结直肠癌中，不完全肿瘤细胞减灭术、肝转移以及梗阻和穿孔表现与较差的生存相关。
通过怀卡托剖腹术服务，在 AoNZ 中实现了 CRS/HIPEC 治疗腹膜表面恶性肿瘤的有利长期结果。
