Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy for Colorectal and Appendiceal Peritoneal Metastasis: The Experience of China Medical University Hospital

腫瘤減積手術加腹腔內熱化療治療大腸直腸癌、闌尾癌併發腹膜轉移病患：中國醫藥大學附設醫院經驗分享

何建霖(Chien-Lin Ho) ； 張伸吉(Sheng-Chi Chang) ； 柯道維(Tao-Wei Ke) ； 陳宏彰(Hung-Chang Chen) ； 蔡元耀(Yuan-Yao Tsai) ； 謝明皓(Ming Hao Hsieh) ； 陳奕彰(Yi-Chang Chen) ； 黃晟瑋(Cheng-Wei Huang) ； 張文睿(Wun-Ruei Chang) ； 王輝明(Hwei-Ming Wang) ； 陳自諒(William Tzu-Liang Chen)

《中華民國大腸直腸外科醫學會雜誌》 33卷3期 (2022/09) Pp. 145-155

https://doi.org/10.6312/SCRSTW.202209_33(3).11113

摘要

Purpose. The aim of this study was to evaluate the safety and oncological survival of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for colorectal and appendiceal peritoneal metastasis. Methods. We report a retrospective, single-center, case series from our prospective database. We reviewed the data of patients with colorectal and appendiceal peritoneal metastasis treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy at our hospital between 2016-2021. The exclusion criteria were peritoneal cancer index ＞ 15, old age (＞ 80 years), Eastern Cooperative Oncology Group performance status ＞ 1, completeness of cytoreduction score ≥ 2, unresectable extraperitoneal metastasis, and palliative or prophylactic hyperthermic intraperitoneal chemotherapy. The relationships between clinical variables and tumor relapse were examined using univariate and multivariate analyses. Results. Of the 96 consecutive patients who underwent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, the overall morbidity was 34.4%, with major complications in 11 patients (11%). The mean duration of hospital stay was 12.8 days. The median relapse-free survival and peritoneal recurrence-free survival were 16.37 ± 2.17 and 21.77 ± 10.67 months, respectively. The 5-year overall survival rate, relapse-free survival, and peritoneal recurrence-free survival was 51.4%, 21.6%, 42.9%, respectively. Multivariable analysis identified more prior systemic chemotherapy (odds ratio, 2.08) and complete cytoreductive score = 1 (odds ratio, 2.39) as independent risk factors for tumor relapse. Conclusions. Our experience demonstrated the safety of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy and its acceptable oncologic survival. However, further randomized studies are required to validate our findings.

關鍵字

Colorectal appendiceal peritoneal metastasis ； Cytoreductive surgery ； HIPEC ； Survival ； Risk factors

並列摘要

目的：此研究之目的在於評估腫瘤減積手術併腹腔內溫熱化學治療用於治療大腸直腸癌及闌尾癌腹膜轉移的安全性及存活率。方法：此為回顧性、單一醫學中心、病例系列（case series）研究，使用中國醫藥大學附設醫院的病患資料庫。時間從2016至2021年止，我們回顧了在此時間內接受過腫瘤減積手術併腹腔內溫熱化學治療的病患。受試者排除條件為腹膜轉移分數評估＞ 15分，年齡大於80歲，ECOG ＞ 1，Completeness of cytoreduction score（CC score）≥ 2，有無法切除乾淨的腹膜外轉移、緩和性及預防性的腹腔內熱化療。研究使用單變數及多變數分析探討腫瘤復發的危險因子。結果：一共96位病患，整體的併發症機率為34.4%，其中有11位病患產生嚴重併發症（11%）。平均住院天數為12.8天。中位數腫瘤無復發存活期及中位數無腹膜腫瘤復發存活期分別為16.37 ± 2.17個月及21.77 ± 10.67個月。五年整體存活率（OS）、無復發存活率（RFS）、無腹膜腫瘤復發存活率（Peri-RFS）分別為51.4%、21.6%及42.9%。多變量分析發現腫瘤復發的獨立危險因子為術前接受過較後線的化學治療（使用超過兩線以上化學治療，OR: 2.08）及完全減量評估分數為1分以上（OR = 2.39）。結論：我們的經驗證實了腫瘤減積手術併腹腔溫熱化學的安全性及可接受的腫瘤相關的存活期，然而，此結果仍需要隨機對照試驗證實。

並列關鍵字

大腸直腸癌及闌尾癌腹腔轉移 ； 腫瘤減積手術 ； 腹腔內熱化療 ； 存活率 ； 危險因子