Souadka Amine, Habbat Hajar, Makni Amin, Abid Mourad, El Mouatassim Zakaria, Daghfous Amin, Korjani Zakia, Rebai Wael, Ayadi Mouna, Messai Wafa Hania, Majbar Mohammed Anass, Benkabbou Amine, Mohsine Raouf, Souadka Abdelilah
Surgical Oncology Department, National Institute of Oncology, Mohammed V University, Rabat 10000, Morocco.
Surgical Department A, Rabta Hospital, Tunis 1007, Tunisia.
Cancers (Basel). 2025 Jun 24;17(13):2113. doi: 10.3390/cancers17132113.
Peritoneal surface malignancies (PSM) are aggressive cancers with limited treatment access in low- and middle-income countries (LMICs). While cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have improved survival outcomes globally, their feasibility in LMICs remains underexplored. This first multicenter study in North Africa evaluates the implementation and outcomes of CRS with or without HIPEC in resource-limited settings. A retrospective cohort study of 391 patients with PSM (colorectal cancer, pseudomyxoma peritonei, ovarian cancer, gastric cancer, or mesothelioma) treated with CRS ± HIPEC between 2014 and 2020 at four tertiary centers in Morocco, Tunisia, and Algeria. Primary outcomes included overall survival (OS), disease-free survival (DFS), and severe postoperative morbidity (Clavien-Dindo ≥ IIIa). Cox regression was used to identify independent prognostic factors. Among 391 patients, complete cytoreduction (CC-0/1) was achieved in 88%, and HIPEC was performed in 39%. Severe morbidity occurred in 22%, with HIPEC, spleno-pancreatectomy, and incomplete cytoreduction (CC-2) identified as significant risk factors. The median OS was 68 months, with 1- and 5-year survival rates of 97% and 56%, respectively. Patients undergoing CRS + HIPEC had significantly longer OS than CRS alone (70 vs. 64 months, = 0.016), though DFS was not significantly different between groups. Independent predictors of improved OS included HIPEC, CC score, PCI, and primary tumor type. This first North African multicenter study establishes the feasibility and efficacy of CRS and HIPEC in LMICs, achieving survival outcomes comparable to high-income settings. The findings support expanding advanced PSM treatment programs in resource-limited settings, emphasizing structured training and multidisciplinary collaboration to improve access and outcomes.
腹膜表面恶性肿瘤（PSM）是侵袭性癌症，在低收入和中等收入国家（LMICs）中治疗途径有限。虽然细胞减灭术（CRS）和腹腔热灌注化疗（HIPEC）在全球范围内改善了生存结果，但其在LMICs中的可行性仍未得到充分探索。这项在北非进行的首个多中心研究评估了在资源有限的环境中进行CRS联合或不联合HIPEC的实施情况和结果。对2014年至2020年期间在摩洛哥、突尼斯和阿尔及利亚的四个三级中心接受CRS±HIPEC治疗的391例PSM患者（结直肠癌、腹膜假黏液瘤、卵巢癌、胃癌或间皮瘤）进行回顾性队列研究。主要结局包括总生存期（OS）、无病生存期（DFS）和严重术后并发症（Clavien-Dindo≥IIIa级）。采用Cox回归分析确定独立预后因素。在391例患者中，88%实现了完全细胞减灭（CC-0/1），39%接受了HIPEC治疗。22%发生了严重并发症，HIPEC、脾胰切除术和不完全细胞减灭（CC-2）被确定为显著危险因素。中位OS为68个月，1年和5年生存率分别为97%和56%。接受CRS+HIPEC治疗的患者OS明显长于单纯CRS治疗患者（70个月对64个月，P=0.016），尽管两组之间DFS无显著差异。OS改善的独立预测因素包括HIPEC、CC评分、PCI和原发肿瘤类型。这项北非首个多中心研究证实了CRS和HIPEC在LMICs中的可行性和有效性，生存结果与高收入地区相当。研究结果支持在资源有限的环境中扩大晚期PSM治疗项目，强调结构化培训和多学科协作以改善治疗可及性和结果。
