Tonello Marco, Cenzi Carola, Pizzolato Elisa, Martini Manuela, Pilati Pierluigi, Sommariva Antonio
Unit of Surgical Oncology of the Digestive Tract, Surgical Oncology Department, Veneto Institute of Oncology IOV-IRCCS, Padua, Castelfranco Veneto, TV, Italy.
Clinical Research Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy.
Ann Surg Oncol. 2025 May 24. doi: 10.1245/s10434-025-17518-z.
National guidelines (GLs) for surgical cytoreduction (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in the management of peritoneal malignancies (PMs) vary across countries, scientific societies, and government agencies. This study aimed to systematically review and compare the recommendations for CRS/HIPEC in the treatment of ovarian cancer (EOC), gastric cancer, colorectal cancer (CRC), mesothelioma, and pseudomyxoma peritonei (PMP).
Medical databases, search engines, and national websites of 193 countries were queried using artificial intelligence (AI)-powered software for scientific societies and/or government agencies guidelines. The study excluded consensus statements and guidelines without appropriate references. Non-English guidelines were translated, and data, including GRADE strength of recommendations, were extracted.
The study analyzed 138 guidelines, 24 for gastric cancer, 36 for colorectal cancer, 29 for primary ovarian cancer (p-)EOC, 28 for recurrent ovarian cancer (r-)EOC, 10 for mesothelioma, and 11 for PMP. Guidelines were retrieved from 51 (26.4%) nations, mostly from developed countries (62.1%; p < 0.001). The CRS procedure received robust positive recommendations (GRADE I/IIa) for CRC (74.2%), p-/r-EOC (100%/78.5%), PMP (90.9%), and mesothelioma (90.0%). Conversely, CRS was not indicated for gastric cancer (61.6%, GRADE III; p < 0.001). The HIPEC procedure had robust positive recommendations for PMP (90.9%) and mesothelioma (90.0%), but was controversial for p-EOC (42.3%) and CRC (38.0%) and contraindicated for r-EOC (80.0%) and gastric cancer (62.4%) (p < 0.001).
National guidelines concordantly recommend CRS for colorectal cancer, ovarian cancer, PMP, and mesothelioma. In contrast, HIPEC recommendations are less homogeneously shared, except for PMP and mesothelioma. No positive concordance exists among guidelines on gastric cancer for CRS nor HIPEC. Furthermore, high-level evidence is needed to strengthen future guidelines on peritoneal metastases.
各国、科学协会及政府机构针对手术细胞减灭术（CRS）和热灌注化疗（HIPEC）治疗腹膜恶性肿瘤（PM）的国家指南存在差异。本研究旨在系统回顾和比较CRS/HIPEC治疗卵巢癌（EOC）、胃癌、结直肠癌（CRC）、间皮瘤和腹膜假黏液瘤（PMP）的推荐意见。
使用人工智能驱动的软件查询193个国家的医学数据库、搜索引擎和国家网站，以获取科学协会和/或政府机构的指南。本研究排除了无适当参考文献的共识声明和指南。对非英文指南进行翻译，并提取包括推荐意见的GRADE强度等数据。
本研究分析了138项指南，其中24项针对胃癌，36项针对结直肠癌，29项针对原发性卵巢癌（p-）EOC，28项针对复发性卵巢癌（r-）EOC，10项针对间皮瘤，11项针对PMP。指南来自51个（26.4%）国家，大部分来自发达国家（62.1%；p<0.001）。CRS手术在结直肠癌（74.2%）、p-/r-EOC（100%/78.5%）、PMP（90.9%）和间皮瘤（90.0%）的治疗中获得了强有力的积极推荐（GRADE I/IIa）。相反，CRS不适用于胃癌（61.6%，GRADE III；p<0.001）。HIPEC手术在PMP（90.9%）和间皮瘤（90.0%）的治疗中获得了强有力的积极推荐，但在p-EOC（42.3%）和结直肠癌（38.0%）的治疗中存在争议，在r-EOC（80.0%）和胃癌（62.4%）的治疗中为禁忌（p<0.001）。
国家指南一致推荐CRS用于结直肠癌、卵巢癌、PMP和间皮瘤的治疗。相比之下，除PMP和间皮瘤外，HIPEC的推荐意见缺乏一致性。胃癌CRS和HIPEC的指南之间不存在积极的一致性。此外，需要高级别证据来加强未来关于腹膜转移的指南。
