Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France.
Department of Medical Information, Lille University Hospital, Lille, France.
Ann Surg Oncol. 2024 Sep;31(9):6220-6227. doi: 10.1245/s10434-024-15180-5. Epub 2024 Mar 28.
Addition of oxaliplatin-based hyperthermic intraperitoneal chemotherapy (HIPEC) to cytoreductive surgery (CRS) in the treatment of peritoneal metastases of colorectal origin (CRPM) did not show any survival benefit in the PRODIGE 7 trial (P7). This study aimed to investigate whether perioperative outcomes after CRS alone for CRPM patients is mediated by hospital volume and to determine the effect of P7 on French practice for CRPM patients treated respectively with CRS alone and CRS/HIPEC.
Data from CRPM patients treated with CRS alone between 2013 and 2020 in France were collected through a national medical database. The study used a cutoff value of the annual CRS-alone caseload affecting the 90-day postoperative mortality (POM) determined from our previous study to define low-volume (LV) HIPEC and high-volume (HV) HIPEC centers. Perioperative outcomes were compared between no-HIPEC, LV-HIPEC, and HV-HIPEC centers. The trend between years and HIPEC rates was analyzed using the Cochrane-Armitage test.
Data from 4159 procedures were analyzed. The patients treated in no-HIPEC and LV-HIPEC centers were older compared with HV-HIPEC centers (p < 0.0001) and had a higher Elixhauser comorbidity index (p < 0.0001) and less complex surgery (p < 0.0001). Whereas the major morbidity (MM) rate did not differ between groups (p = 0.79), the 90-day POM was lower in HV-HIPEC centers than in no-HIPEC and LV-HIPEC centers (5.4% vs 15% and 13.3%; p < 0.0001), with lower failure-to-rescue (FTR) (p < 0.0001). After P7, the CRS/HIPEC rate decreased drastically in Cancer centers (p < 0.001), whereas patients treated with CRS alone are still referred to expert centers.
Centralization of CRS alone should improve patient selection as well as FTR and POM. After P7, CRS/HIPEC decreased mostly in Cancer centers, without any impact on the number of CRS-alone cases referred to expert centers.
在 PRODIGE 7 试验（P7）中，结直肠癌腹膜转移（CRPM）患者接受细胞减灭术（CRS）联合奥沙利铂为基础的腹腔热灌注化疗（HIPEC）治疗并未显示出任何生存获益。本研究旨在探讨 CRPM 患者行 CRS 治疗后围手术期结局是否由医院容量介导，并确定 P7 对仅行 CRS 和 CRS/HIPEC 治疗的 CRPM 患者法国治疗实践的影响。
通过国家医疗数据库收集 2013 年至 2020 年期间仅接受 CRS 治疗的 CRPM 患者的数据。本研究使用从我们之前的研究中确定的影响 90 天术后死亡率（POM）的年度 CRS 单独病例数的截止值来定义低容量（LV）HIPEC 和高容量（HV）HIPEC 中心。比较无 HIPEC、LV-HIPEC 和 HV-HIPEC 中心之间的围手术期结局。使用 Cochrane-Armitage 检验分析年份和 HIPEC 率之间的趋势。
共分析了 4159 例手术。与 HV-HIPEC 中心相比，无 HIPEC 和 LV-HIPEC 中心的患者年龄更大（p<0.0001），合并症 Elixhauser 指数更高（p<0.0001），手术复杂性更低（p<0.0001）。尽管各组之间的主要发病率（MM）率无差异（p=0.79），但 HV-HIPEC 中心的 90 天 POM 低于无 HIPEC 和 LV-HIPEC 中心（5.4% vs 15%和 13.3%；p<0.0001），失败挽救率（FTR）更低（p<0.0001）。在 P7 之后，癌症中心的 CRS/HIPEC 率急剧下降（p<0.001），而仅接受 CRS 治疗的患者仍被转诊至专家中心。
CRS 单一治疗的集中化应改善患者选择以及 FTR 和 POM。在 P7 之后，CRS/HIPEC 主要在癌症中心减少，而转诊至专家中心的 CRS 单一治疗病例数量没有任何影响。
