Role of Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy (CRS/HIPEC) in the Treatment of Peritoneal Carcinomatosis From Small Bowel Adenocarcinoma-A Systematic Review and Meta-Analysis.

IF 2 3区 医学 Q3 ONCOLOGY
Deemantha G Fernando, Rodney Sparapani, Harveshp Mogal
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引用次数: 0

Abstract

Introduction: While systemic chemotherapy (SC) is the mainstay of treatment of peritoneal carcinomatosis from small bowel adenocarcinomas (SBA-PC), its efficacy and outcomes remain poor. Therefore, the role of curative-intent surgery needs to be better defined. Using a systematic review and meta-analysis, this study aims to define the role of CRS/HIPEC in patients with SBA-PC.

Methods: A systematic literature search was performed using PubMed and MEDLINE following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for studies published between 1990 and 2023. Articles were scored and incorporated within approximate normality of means/proportions formulae to compare outcomes of CRS/HIPEC and SC alone.

Results: Ten studies with 461 patients undergoing CRS/HIPEC and seven studies with 285 patients undergoing SC alone were identified. In the CRS/HIPEC group, 215 (46.6%) were male and the median age was 46.5-66 years. The primary tumor was located mostly in the duodenum (n = 169, 36.7%) and ileum (n = 108, 23.4%). Grade was unspecified in most patients (n = 232, 50.3%). Median Peritoneal Cancer Index (PCI) ranged between 10 and 12, and 93.1% underwent complete cytoreduction (CC 0/1). CRS/HIPEC-related major morbidity and mortality was 20.7% (SD = 2.5, 95% CI 15.6-25.6) and 1.7% (SD = 0.8, 95% CI 0.1-3.3), respectively. With a median follow-up of 21.1 (SD = 1.1, 95% CI 18.9-23.3) months, CRS/HIPEC demonstrated median overall survival of 32.3 (SD = 1.19, 95% CI 30-34.6) versus 14.5 (SD = 0.19, 95% CI 14.1-14.9) months for SC alone (p < 0.0003).

Conclusion: In comparison to SC alone, CRS/HIPEC may result in long-term survival with acceptable perioperative morbidity, in select SBA-PC patients with low-volume disease undergoing complete cytoreduction.

细胞减灭术和腹腔内热化疗(CRS/HIPEC)在治疗小肠腺癌腹膜癌肿中的作用--系统回顾和荟萃分析。
简介:虽然全身化疗(SC)是治疗小肠腺癌腹膜癌肿(SBA-PC)的主要方法,但其疗效和预后仍然不佳。因此,需要更好地界定治愈性手术的作用。本研究采用系统综述和荟萃分析法,旨在明确 CRS/HIPEC 在 SBA-PC 患者中的作用:方法:按照系统综述和荟萃分析首选报告项目(PRISMA)指南,使用 PubMed 和 MEDLINE 对 1990 年至 2023 年间发表的研究进行了系统文献检索。对文章进行评分,并纳入近似正态均值/比例公式,以比较 CRS/HIPEC 和单纯 SC 的结果:结果:共发现10项研究,461名患者接受了CRS/HIPEC治疗;7项研究,285名患者仅接受了SC治疗。在 CRS/HIPEC 组中,215 名(46.6%)患者为男性,中位年龄为 46.5-66 岁。原发肿瘤主要位于十二指肠(169 例,36.7%)和回肠(108 例,23.4%)。大多数患者的肿瘤分级不明(232例,50.3%)。腹膜癌指数(PCI)中位数介于 10 和 12 之间,93.1% 的患者接受了完全细胞减灭术(CC 0/1)。与 CRS/HIPEC 相关的主要发病率和死亡率分别为 20.7% (SD = 2.5, 95% CI 15.6-25.6) 和 1.7% (SD = 0.8, 95% CI 0.1-3.3)。中位随访时间为 21.1 个月(SD = 1.1,95% CI 18.9-23.3),CRS/HIPEC 的中位总生存期为 32.3 个月(SD = 1.19,95% CI 30-34.6),而单用 SC 的中位总生存期为 14.5 个月(SD = 0.19,95% CI 14.1-14.9)(P 结论:CRS/HIPEC 与单用 SC 相比,CRS/HIPEC 的中位总生存期更长:与单纯 SC 相比,CRS/HIPEC 可使部分接受完全细胞减灭术的低容量 SBA-PC 患者获得长期生存,且围术期发病率可接受。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
4.70
自引率
4.00%
发文量
367
审稿时长
2 months
期刊介绍: The Journal of Surgical Oncology offers peer-reviewed, original papers in the field of surgical oncology and broadly related surgical sciences, including reports on experimental and laboratory studies. As an international journal, the editors encourage participation from leading surgeons around the world. The JSO is the representative journal for the World Federation of Surgical Oncology Societies. Publishing 16 issues in 2 volumes each year, the journal accepts Research Articles, in-depth Reviews of timely interest, Letters to the Editor, and invited Editorials. Guest Editors from the JSO Editorial Board oversee multiple special Seminars issues each year. These Seminars include multifaceted Reviews on a particular topic or current issue in surgical oncology, which are invited from experts in the field.
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