Colorectal Cancer Center, School of Medicine, Kyungpook National University Chilgok Hospital, Kyungpook National University, Daegu, Republic of Korea.
Department of Medical Statistics, School of Medicine, Daegu Catholic University, Daegu, Republic of Korea.
Ann Surg Oncol. 2024 Oct;31(10):7111-7121. doi: 10.1245/s10434-024-15674-2. Epub 2024 Jul 29.
The selection of hyperthermic intraperitoneal chemotherapy (HIPEC) or early postoperative intraperitoneal chemotherapy (EPIC) for peritoneal metastases from colorectal cancer or appendiceal neoplasms following cytoreductive surgery (CRS) depends on the surgeon's discretion. This study was designed to compare postoperative and oncologic outcomes of HIPEC and EPIC using inverse probability of treatment weighting (IPTW).
This study included 175 patients who received HIPEC or EPIC following CRS at a single tertiary university hospital between December 1999 and December 2020. Inverse probability of treatment weighting analysis was performed to control for pretreatment characteristics between the two groups. Multivariate analysis was performed to determine factors associated with postoperative and survival outcomes.
After IPTW, no significant differences in baseline demographics and tumor characteristics were observed between the two groups. The HIPEC group had a significantly longer operation time than the EPIC group. The EPIC group showed a significantly higher postoperative mortality rate than the HIPEC group. Operation time (odds ratio [OR] 1.01; 95% confidence interval [CI] 1.01-1.02; p < 0.001), bowel anastomosis (OR 7.25; 95% CI 1.16-45.2; p = 0.034), neoadjuvant chemotherapy (OR 7.62; 95% CI 1.85-31.4; p = 0.005), and EPIC (OR 8.76; 95% CI 2.16-35.5; p = 0.002) were independent risk factors for major surgical complications. No association was observed between intraperitoneal chemotherapy type and major hematologic toxicity, overall survival, progression-free survival, or peritoneal progression-free survival.
EPIC was a risk factor for major surgical complications. Survival outcomes were similar between the two types of intraperitoneal chemotherapy.
结直肠或阑尾肿瘤细胞减灭术后行腹腔热灌注化疗（HIPEC）或早期术后腹腔内化疗（EPIC）的选择取决于外科医生的判断。本研究旨在通过逆概率治疗加权（IPTW）比较 HIPEC 和 EPIC 的术后和肿瘤学结果。
本研究纳入了 1999 年 12 月至 2020 年 12 月在一家三级大学医院接受 HIPEC 或 EPIC 治疗的 175 例患者。通过逆概率治疗加权分析控制两组之间的预处理特征。采用多因素分析确定与术后和生存结局相关的因素。
经 IPTW 后，两组患者的基线人口统计学和肿瘤特征无显著差异。HIPEC 组的手术时间明显长于 EPIC 组。EPIC 组的术后死亡率明显高于 HIPEC 组。手术时间（比值比 [OR] 1.01；95%置信区间 [CI] 1.01-1.02；p < 0.001）、肠吻合术（OR 7.25；95% CI 1.16-45.2；p = 0.034）、新辅助化疗（OR 7.62；95% CI 1.85-31.4；p = 0.005）和 EPIC（OR 8.76；95% CI 2.16-35.5；p = 0.002）是重大手术并发症的独立危险因素。未观察到腹腔内化疗类型与主要血液学毒性、总生存、无进展生存或腹膜无进展生存之间存在关联。
EPIC 是重大手术并发症的危险因素。两种类型的腹腔内化疗的生存结果相似。
