Cytoreductive Surgery With Hyperthermic Intraperitoneal Chemotherapy and Liver Resection is a Treatment Option for Patients With Peritoneal and Liver Metastases From Colorectal Cancer.

IF 7.5 1区 医学 Q1 SURGERY
Annals of surgery Pub Date : 2024-11-01 Epub Date: 2024-08-26 DOI:10.1097/SLA.0000000000006492
Vegar Johansen Dagenborg, Kristoffer Watten Brudvik, Christin Lund-Andersen, Annette Torgunrud, Marius Lund-Iversen, Kjersti Flatmark, Stein Gunnar Larsen, Sheraz Yaqub
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引用次数: 0

Abstract

Objective: To study outcomes after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) in patients also treated for colorectal liver metastases (CLM).

Background: Colorectal cancer (CRC) frequently metastasizes to the liver and peritoneum and is associated with a poor prognosis. In selected patients, a benefit in overall survival (OS) was shown for both peritoneal metastases (PM-CRC) offered CRS-HIPEC, and CLM treated with surgical resection. However, the presence of CLM was considered a relative contraindication to CRS-HIPEC, causing a paucity of outcome data in this patient group.

Methods: Patients with PM-CRC having CRS-HIPEC at a single national center between 2007 and 2023, with additional intervention for CLM, were included (previous curative treatment for extraperitoneal and extrahepatic metastases was allowed). Three groups were defined: CLM before CRS-HIPEC (pre-CRS-HIPEC), CLM resected simultaneously with CRS-HIPEC (sim-CRS-HIPEC), and CLM after CRS-HIPEC (post-CRS-HIPEC), aiming to retrospectively analyze outcomes.

Results: Fifty-seven patients were included and classified as: pre-CRS-HIPEC (n = 11), sim-CRS-HIPEC (n = 29), and post-CRS-HIPEC (n = 17). Median Peritoneal Cancer Index (PCI) was 8; 13 patients had severe complications (Clavien-Dindo ≥3), and no 90-day mortality. Median OS was 48 months after CRS-HIPEC. PCI was a predictor of OS (hazard ratio: 1.11, P < 0.001). We observed no difference in short or long-term outcomes between intervention groups.

Discussion: This study demonstrated that patients with CLM having CRS-HIPEC had comparable OS to reports on CRS-HIPEC only, likely explained by a low PCI. Simultaneous CLM resection did not increase the risk of severe complications.

Conclusions: In this national cohort, CRS-HIPEC and CLM intervention offers long-term survival, suggesting that this treatment may be offered to selected patients with PM-CRC and CLM.

腹腔内热化疗和肝脏切除的细胞剥脱手术是结直肠癌腹膜和肝脏转移患者的一种治疗选择。
背景:结直肠癌经常转移至肝脏和腹膜,预后较差。在选定的患者中,腹膜转移(PM-CRC)患者接受细胞切除手术和腹腔内热化疗(CRS-HIPEC),以及结直肠肝转移(CLM)患者接受手术切除治疗后,总生存期(OS)均有获益。然而,CLM的存在被认为是CRS-HIPEC的相对禁忌症,导致该患者群体的结果数据很少:研究设计:纳入 2007 年至 2023 年期间在一个国家中心接受 CRS-HIPEC 治疗的 PM-CRC 患者,并对 CLM 进行额外干预(允许之前对腹膜外和肝外转移瘤进行过治愈性治疗)。共分为三组CRS-HIPEC前的CLM(preCRS-HIPEC);与CRS-HIPEC同时切除的CLM(simCRS-HIPEC);CRS-HIPEC后的CLM(postCRS-HIPEC),旨在对结果进行回顾性分析:结果:共纳入57例患者,分为:CRS-HIPEC前(11例)、simCRS-HIPEC(29例)和CRS-HIPEC后(17例)。腹膜癌指数(PCI)中位数为 8,13 名患者出现严重并发症(Clavien-Dindo ≥3),无 90 天死亡病例。CRS-HIPEC术后的中位OS为48个月。PCI是预测OS的指标(HR 1.11,PD讨论:这项研究表明,接受CRS-HIPEC治疗的CLM患者的OS与仅接受CRS-HIPEC治疗的患者相当,这可能是因为PCI较低。同时进行CLM切除术不会增加严重并发症的风险:在这个全国性队列中,CRS-HIPEC和CLM干预可提供长期生存,这表明这种治疗方法可提供给选定的PM-CRC和CLM患者。
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来源期刊
Annals of surgery
Annals of surgery 医学-外科
CiteScore
14.40
自引率
4.40%
发文量
687
审稿时长
4 months
期刊介绍: The Annals of Surgery is a renowned surgery journal, recognized globally for its extensive scholarly references. It serves as a valuable resource for the international medical community by disseminating knowledge regarding important developments in surgical science and practice. Surgeons regularly turn to the Annals of Surgery to stay updated on innovative practices and techniques. The journal also offers special editorial features such as "Advances in Surgical Technique," offering timely coverage of ongoing clinical issues. Additionally, the journal publishes monthly review articles that address the latest concerns in surgical practice.
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