Background:Advances in cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) and pressurized intraperitoneal aerosol chemotherapy (PIPAC) have improved outcomes for selected patients with peritoneal surface malignancies (PSMs).Methods:This retrospective study analyzed 743 PSM patients treated at Fondazione Policlinico Universitario Agostino Gemelli from January 2016 to February 2024. The primary aim was to assess median overall survival (mOS), median disease-free survival (mDFS), and median progression-free survival (mPFS) stratified by tumor origin. Secondary outcomes examined the role of diagnostic laparoscopy in the management of PSMs and intra- and postoperative complications’ rates.Results:A total of 1113 procedures were performed: 389 CRS, 370 PIPAC, and 354 diagnostic laparoscopies. Colorectal cancer was the predominant indication for CRS (52.4%), with a mOS of 52 months and mDFS of 22 months. Patients affected by gastric cancer undergoing CRS had a mOS of 18 months and a mDFS of 13 months, while PIPAC yielded a mOS of 9 months and a mPFS of 4 months. Among patients with pseudomyxoma peritonei undergoing CRS, the 5-year DFS rate was 64.1%, and OS rate was 89%. Patients affected by mesothelioma and treated with CRS exhibited a median OS of 43 months and a DFS of 26 months. Pancreatic and hepatobiliary cancers were treated with PIPAC, with a respective mOS of 12 and 8 months. Postoperative complications occurred in 12.6% of CRS, 3.2% of PIPAC, and 1.7% of diagnostic laparoscopies. High peritoneal cancer index (PCI), gastric resection, and blood loss over 500 mL were identified as risk factors for major complications in a multivariate analysis.Conclusions:Developing a highly experienced multidisciplinary team is crucial for delivering tailored treatment strategies which aim to achieve optimal oncological outcomes while preserving patients’ quality of life.
背景：细胞减灭术（CRS）联合腹腔热灌注化疗（HIPEC）及腹腔加压气溶胶化疗（PIPAC）的技术进展，为特定腹膜表面恶性肿瘤（PSMs）患者改善了治疗结局。方法：本回顾性研究分析了2016年1月至2024年2月在Agostino Gemelli大学综合医院基金会接受治疗的743例PSM患者。主要目的是评估按肿瘤来源分层的中位总生存期（mOS）、中位无病生存期（mDFS）和中位无进展生存期（mPFS）。次要结局指标包括诊断性腹腔镜在PSM管理中的作用以及术中术后并发症发生率。结果：共实施1113例手术操作：389例CRS、370例PIPAC及354例诊断性腹腔镜。结直肠癌是CRS的主要适应症（52.4%），其mOS为52个月，mDFS为22个月。接受CRS的胃癌患者mOS为18个月，mDFS为13个月；而接受PIPAC治疗者mOS为9个月，mPFS为4个月。腹膜假黏液瘤患者接受CRS治疗后，5年DFS率为64.1%，OS率为89%。接受CRS治疗的间皮瘤患者中位OS为43个月，DFS为26个月。胰腺癌和肝胆管癌采用PIPAC治疗，mOS分别为12个月和8个月。术后并发症发生率在CRS组为12.6%，PIPAC组为3.2%，诊断性腹腔镜组为1.7%。多变量分析显示，高腹膜癌指数（PCI）、胃切除术及失血量超过500 mL是主要并发症的危险因素。结论：组建经验丰富的多学科团队对于制定个体化治疗策略至关重要，该策略旨在实现最佳肿瘤学结局的同时保障患者生活质量。
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