Jacquet P, Stephens A D, Averbach A M, Chang D, Ettinghausen S E, Dalton R R, Steves M A, Sugarbaker P H
The Washington Cancer Institute, Washington Hospital Center, Washington, D.C. 20010, USA.
Cancer. 1996 Jun 15;77(12):2622-9. doi: 10.1002/(SICI)1097-0142(19960615)77:12<2622::AID-CNCR28>3.0.CO;2-T.
Peritoneal carcinoma has been regarded as a uniformly lethal clinical entity. A treatment plan combining cytoreductive surgery and heated intraoperative intraperitoneal chemotherapy (HIIC) was devised and tested to treat such patients. The purpose of this study was to evaluate the morbidity and mortality associated with this treatment approach.
Sixty patients with peritoneal carcinomatosis from adenocarcinoma of the colon or appendix were included in the study. Extensive cytoreductive surgery was combined with heated intraperitoneal mitomycin in an intraoperative lavage technique followed by one cycle of early postoperative intraperitoneal 5-fluorouracil. Eleven clinical variables were selected and statistically correlated with morbidity and mortality.
Twenty-five complications occurred in 21 patients (morbidity = 35%). Morbidity related to gastrointestinal function included anastomotic leak (n=6), bowel perforations (n=5), bile leak (n=3), and pancreatitis (n=2). Four patients presented with severe hematologic toxicity (Grade 3 or 4). There were three cases of postoperative bleeding, one case of abdominal wound dehiscence, and one case of pulmonary embolism. Morbidity was significantly associated with three clinical factors: male sex, high intraabdominal temperature during HIIC, and duration of the surgical procedure. Enteral complications (bowel fistula and anastomotic leak) occurred in patients with a significantly higher number of peritonectomy procedures and a significantly longer operation. Three patients died within 8 weeks after the procedure (mortality = 5%). Mortality was significantly associated with age and intraabdominal temperature.
Cytoreductive surgery combined with HIIC is associated with a 35% morbidity rate and a 5% mortality rate. Extensive surgery (duration and number of peritonectomy procedures) and high intraabdominal temperature represent the major risk factors for postoperative morbidity and mortality of patients treated with this new therapeutic approach.
腹膜癌一直被视为一种 uniformly lethal 的临床实体。设计并测试了一种将细胞减灭术与术中温热腹腔内化疗（HIIC）相结合的治疗方案来治疗此类患者。本研究的目的是评估与这种治疗方法相关的发病率和死亡率。
60 例来自结肠或阑尾腺癌的腹膜癌患者纳入研究。广泛的细胞减灭术与术中温热丝裂霉素腹腔灌洗技术相结合，随后进行一个周期的术后早期腹腔内 5-氟尿嘧啶治疗。选择了 11 个临床变量，并与发病率和死亡率进行统计学关联。
21 例患者出现 25 种并发症（发病率 = 35%）。与胃肠功能相关的并发症包括吻合口漏（n = 6）、肠穿孔（n = 5）、胆漏（n = 3）和胰腺炎（n = 2）。4 例患者出现严重血液学毒性（3 级或 4 级）。有 3 例术后出血、1 例腹部伤口裂开和 1 例肺栓塞。发病率与三个临床因素显著相关：男性、HIIC 期间腹腔内高温以及手术时间。肠内并发症（肠瘘和吻合口漏）在腹膜切除术数量显著更多且手术时间显著更长的患者中发生。3 例患者在术后 8 周内死亡（死亡率 = 5%）。死亡率与年龄和腹腔内温度显著相关。
细胞减灭术联合 HIIC 的发病率为 35%，死亡率为 5%。广泛的手术（手术时间和腹膜切除术数量）和腹腔内高温是接受这种新治疗方法的患者术后发病率和死亡率的主要危险因素。
