Gil-Gómez Elena, González-Gil Alida, Olivares-Ripoll Vicente, Cerezuela-Fernández de Palencia Álvaro, López-Hernández Francisco, Martínez-Espí Álvaro, Martínez-García Jerónimo, Barceló Francisco, Guijarro-Campillo Alberto Rafael, Cascales-Campos Pedro Antonio
Peritoneal Carcinomatosis and Sarcomas Unit, Department of Surgery, Hospital Universitario Virgen De La Arrixaca, IMIB-Arrixaca, 30120 Murcia, Spain.
Department of Medical Oncology, Hospital Universitario Virgen De La Arrixaca, IMIB-Arrixaca, 30120 Murcia, Spain.
Cancers (Basel). 2025 Apr 25;17(9):1445. doi: 10.3390/cancers17091445.
This study aimed to analyze the morbidity, mortality, and survival outcomes in patients with peritoneal surface malignancies who were initially considered candidates for cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) but were found to have unresectable disease, resulting in nontherapeutic exploratory laparotomy.
We evaluated data from our referral center for the treatment of peritoneal surface malignancies between January 2008 and December 2022. Adverse events following nontherapeutic laparotomy were classified using the National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.0.
Among a cohort of 486 patients with peritoneal surface malignancies initially considered candidates for CRS + HIPEC, 46 cases (9.4%) were aborted due to the disease being deemed unresectable during exploratory laparotomy. The primary reasons for unresectability included extensive disease spread, observed in 28 patients, with massive small intestine involvement detected in 13 of these cases. The median duration of surgery was 90 min (range: 60-180 min). Postoperative complications occurred in 10 patients (22%), with a mortality rate of 4.3% (2 patients). Survival was significantly lower in patients who did not receive adjuvant systemic chemotherapy with palliative intent (4 months vs. 15 months, < 0.01).
Exploratory laparotomy in patients with peritoneal surface malignancies considered for CRS with HIPEC carries a substantial risk of complications. Improved preoperative staging using advanced technologies such as radiomics and laparoscopy is expected to reduce the number of patients undergoing nontherapeutic laparotomy.
本研究旨在分析那些最初被认为适合接受细胞减灭术（CRS）联合腹腔热灌注化疗（HIPEC），但最终被发现存在无法切除的疾病，从而导致非治疗性剖腹探查术的腹膜表面恶性肿瘤患者的发病率、死亡率和生存结局。
我们评估了2008年1月至2022年12月期间我们转诊中心治疗腹膜表面恶性肿瘤的数据。使用美国国立癌症研究所不良事件通用术语标准第4.0版对非治疗性剖腹探查术后的不良事件进行分类。
在486例最初被认为适合CRS+HIPEC的腹膜表面恶性肿瘤患者队列中，有46例（9.4%）因在剖腹探查术中发现疾病无法切除而手术中止。无法切除的主要原因包括广泛的疾病扩散，28例患者出现这种情况，其中13例检测到大量小肠受累。手术的中位持续时间为90分钟（范围：60 - 180分钟）。10例患者（22%）发生术后并发症，死亡率为4.3%（2例患者）。未接受姑息性辅助全身化疗的患者生存率显著较低（4个月对15个月，P<0.01）。
对于考虑接受CRS联合HIPEC的腹膜表面恶性肿瘤患者，剖腹探查术具有较高的并发症风险。使用放射组学和腹腔镜等先进技术改进术前分期，有望减少接受非治疗性剖腹探查术的患者数量。
