Duran-Martínez M, Bergillos-Giménez M, Rodríguez-Ortíz L, Arjona-Sánchez A
Unit of Surgical Oncology, Reina Sofia University Hospital, Cordoba, Spain.
Department of Biochemistry and Molecular Biology, GE09 Research in Peritoneal and Retroperitoneal Oncologic Surgery Group, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofía University Hospital, University of Cordoba, Córdoba, Spain.
J Surg Oncol. 2024 Nov;130(6):1196-1202. doi: 10.1002/jso.27881. Epub 2024 Sep 10.
Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are established treatments for peritoneal surface malignancies, traditionally performed via laparotomy. Recent advancements in laparoscopic approaches (L-CRS + HIPEC) have shown promising results in selected patients.
The PSOGI registry, established in November 2019, collects data from specialized centers performing L-CRS + HIPEC. Data were collected prospectively and analyzed retrospectively, excluding risk-reducing procedures without peritoneal disease. The learning curve was assessed using a 14-cases cutoff.
Today, 323 patients have been registered, 193 were included finally. Perioperative outcomes improved after 14 cases: Length of hospital stay was 7.78 ± 3.64 days (consolidation) versus 8.8 ± 8.79 days (learning) and major morbidity was 0% (consolidation) versus 5% (learning), (p = n.s.). Estimated blood loss was lower in the consolidation phase. Oncological outcomes also improved: Recurrence rate was 8.7% (consolidation) versus 17.8% (learning). Disease-free survival 5 years, 65% (learning) versus 88% (consolidation) (p = 0.012).
The L-CRS + HIPEC is a safe procedure with non-inferior oncologic outcomes which it is evaluating in an IDEAL setting by an international group. The validation of the learning curve, gives us the knowledge that a mentoring program must be setup to reduce the learning curve impact in oncologic failure.
细胞减灭术（CRS）和腹腔内热灌注化疗（HIPEC）是治疗腹膜表面恶性肿瘤的既定疗法，传统上通过剖腹手术进行。腹腔镜手术方法（L-CRS + HIPEC）的最新进展在部分患者中显示出了有前景的结果。
PSOGI登记处成立于2019年11月，收集来自进行L-CRS + HIPEC的专业中心的数据。数据前瞻性收集并回顾性分析，排除无腹膜疾病的降低风险手术。使用14例的截断值评估学习曲线。
如今，已登记323例患者，最终纳入193例。14例之后围手术期结果有所改善：住院时间为7.78±3.64天（巩固期）对比8.8±8.79天（学习期），主要并发症发生率为0%（巩固期）对比5%（学习期），（p =无显著差异）。巩固期估计失血量更低。肿瘤学结果也有所改善：复发率为8.7%（巩固期）对比17.8%（学习期）。5年无病生存率，65%（学习期）对比88%（巩固期）（p = 0.012）。
L-CRS + HIPEC是一种安全的手术，肿瘤学结果不劣，国际组织正在理想环境中对其进行评估。学习曲线的验证让我们认识到必须设立一个指导计划以减少学习曲线对肿瘤学失败的影响。
