BACKGROUND Cytoreductive surgery(CRS)with hyperthermic intraperitoneal chemotherapy(HIPEC)for peritoneal carcinomatosis can be performed in two ways:Open or closed abdominal technique.AIM To evaluate the impact of HIP...BACKGROUND Cytoreductive surgery(CRS)with hyperthermic intraperitoneal chemotherapy(HIPEC)for peritoneal carcinomatosis can be performed in two ways:Open or closed abdominal technique.AIM To evaluate the impact of HIPEC method on post-operative and long-term survival outcomes.METHODS Patients undergoing CRS with HIPEC from 2000-2017 were identified in the United States HIPEC collaborative database.Post-operative,recurrence,and overall survival outcomes were compared between those who received open vs closed HIPEC.RESULTS Of the 1812 patients undergoing curative-intent CRS and HIPEC,372(21%)patients underwent open HIPEC and 1440(79%)underwent closed HIPEC.There was no difference in re-operation or severe complications between the two groups.Closed HIPEC had higher rates of 90-d readmission while open HIPEC had a higher rate of 90-d mortalities.On multi-variable analysis,closed HIPEC technique was not a significant predictor for overall survival(hazards ratio:0.75,95%confidence interval:0.51-1.10,P=0.14)or recurrence-free survival(hazards ratio:1.39,95%confidence interval:1.00-1.93,P=0.05)in the entire cohort.These findings remained consistent in the appendiceal and the colorectal subgroups.CONCLUSION In this multi-institutional analysis,the HIPEC method was not independently associated with relevant post-operative or long-term outcomes.HIPEC technique may be left to the discretion of the operating surgeon.展开更多
文摘既往腹膜表面肿瘤学科的培训常通过医师的个人自学实现,鉴于目前这一学科的发展,对该领域专家的需求越来越大,因此有必要形成组织化的教育和培训方式。在欧洲外科肿瘤学会(ESSO)和国际腹膜表面恶性肿瘤学会(Peritoneal Surface Oncology Group International,PSOGI)的共同努力下,欧洲腹膜表面肿瘤学院(ESPSO)于2014年成立。该组织基于导师制的腹膜表面肿瘤学培训项目,已获得欧洲认证。自该项目成立年至2021年7月14日,共有42名外科医生从该培训项目毕业,其中大多数来自欧洲,也有部分非欧洲的毕业生,这使得该项目具有全球影响力。目前,已有35名候选学员已在欧洲和非欧洲培训中心完成注册。鉴于当前培训的成功,该项目正在加速发展,目前不断有新的教员加入以及新的培训活动开展。欧洲腹膜表面肿瘤学学院成功建立了一个结构化的基于导师制的培训项目,并获得了专业认证。得益于来自全球的大量毕业生和候选学员,使该项目获得了预期的声望,满足了学员的需求,并为本培训项目下一步计划的实施提供了保障。本文主要介绍此培训项目方案。
基金the National Center for Advancing Translational SciencesNo.UL1TR002377。
文摘BACKGROUND Cytoreductive surgery(CRS)with hyperthermic intraperitoneal chemotherapy(HIPEC)for peritoneal carcinomatosis can be performed in two ways:Open or closed abdominal technique.AIM To evaluate the impact of HIPEC method on post-operative and long-term survival outcomes.METHODS Patients undergoing CRS with HIPEC from 2000-2017 were identified in the United States HIPEC collaborative database.Post-operative,recurrence,and overall survival outcomes were compared between those who received open vs closed HIPEC.RESULTS Of the 1812 patients undergoing curative-intent CRS and HIPEC,372(21%)patients underwent open HIPEC and 1440(79%)underwent closed HIPEC.There was no difference in re-operation or severe complications between the two groups.Closed HIPEC had higher rates of 90-d readmission while open HIPEC had a higher rate of 90-d mortalities.On multi-variable analysis,closed HIPEC technique was not a significant predictor for overall survival(hazards ratio:0.75,95%confidence interval:0.51-1.10,P=0.14)or recurrence-free survival(hazards ratio:1.39,95%confidence interval:1.00-1.93,P=0.05)in the entire cohort.These findings remained consistent in the appendiceal and the colorectal subgroups.CONCLUSION In this multi-institutional analysis,the HIPEC method was not independently associated with relevant post-operative or long-term outcomes.HIPEC technique may be left to the discretion of the operating surgeon.
