Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis: Outcomes from a Single Tertiary Institution

被引:60
|
作者
Tabrizian, Parissa [1 ]
Shrager, Brian [2 ]
Jibara, Ghalib [3 ]
Yang, Ming-Jim [1 ]
Romanoff, Anya [1 ]
Hiotis, Spiros [1 ]
Sarpel, Umut [1 ]
Labow, Daniel M. [1 ]
机构
[1] Mt Sinai Med Ctr, New York, NY 10029 USA
[2] Morristown Med Ctr, Morristown, NJ USA
[3] Brookdale Univ Hosp Med Ctr, Dept Urol, Brooklyn, NY USA
关键词
Hyperthermic intraperitoneal chemotherapy; Peritoneal carcinomatosis; Colorectal cancer; Outcome; DIGESTIVE-TRACT CANCER; COLORECTAL-CANCER; BLOOD-LOSS; MORBIDITY; MORTALITY; CHEMOHYPERTHERMIA; MALIGNANCY; MANAGEMENT; COMPLICATIONS; SURVIVAL;
D O I
10.1007/s11605-014-2477-5
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Cytoreductive surgery (CRS) with heated intraperitoneal chemotherapy (HIPEC) is an effective but morbid procedure in the treatment of peritoneal carcinomatosis. We report our outcomes at a single tertiary institution. A total of 170 consecutive patients underwent CRS-HIPEC for peritoneal carcinomatosis between July 2007 and August 2012. The peritoneal cancer index (1-39) was used for peritoneal carcinomatosis (PC) staging. Mitomycin C (88.8 %) was administered intraperitoneally at 42 A degrees C for 90 mins. Risk factors associated with major morbidities were analyzed. The Kaplan-Meier method was used for survival analyses. The mean age was 55.1 (+/- 11.3) years, and the majority (77.1 %) of patients had complete cytoreduction (CC0-1). Tumor types included colorectal (n = 51, 30.0 %), appendiceal (n = 50, 29.4 %), pseudomyxoma peritonei (n = 16, 9.4 %), and other (n = 53, 31.2 %). Factors associated with major complications were estimated blood loss (> 400 ml), length of stay (> 1 week), intraoperative blood transfusion, operative time (> 6 h), and bowel anastomosis. Intraoperative blood transfusion was the only independent prognostic factor on multivariate analysis (p = 0.031). Median follow-up was 15.7 months (+/- 1.2). The recurrence rates for colorectal and appendiceal carcinoma at 1 and 3 years were 40 %, 53.5 % and 68 %, 79.1 %, respectively. The 1- and 3-year overall survival for colorectal and appendiceal carcinomatosis was 74.0 %, 32.5 % and 89.4 %, 29.3 %, respectively. Intraoperative peritoneal cancer index (PCI) score (> 16) and need for blood transfusion were factors independently associated with poor survival (p < 0.05). Our single institution experience of CRS/HIPEC procedures for peritoneal carcinomatosis demonstrates acceptable perioperative outcome and long-term survival. Optimal cytoreduction was achieved in the majority of cases. Intraoperative PCI > 16 was associated with poor survival. This series supports the safety of CRS-HIPEC in selected patients.
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收藏
页码:1024 / 1031
页数:8
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