Background: This study aimed to analyze the morbidity, mortality, and survival outcomes in patients with peritoneal surface malignancies who were initially considered candidates for cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) but were found to have unresectable disease, resulting in nontherapeutic exploratory laparotomy. Patients and Methods: We evaluated data from our referral center for the treatment of peritoneal surface malignancies between January 2008 and December 2022. Adverse events following nontherapeutic laparotomy were classified using the National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.0. Results: Among a cohort of 486 patients with peritoneal surface malignancies initially considered candidates for CRS + HIPEC, 46 cases (9.4%) were aborted due to the disease being deemed unresectable during exploratory laparotomy. The primary reasons for unresectability included extensive disease spread, observed in 28 patients, with massive small intestine involvement detected in 13 of these cases. The median duration of surgery was 90 min (range: 60–180 min). Postoperative complications occurred in 10 patients (22%), with a mortality rate of 4.3% (2 patients). Survival was significantly lower in patients who did not receive adjuvant systemic chemotherapy with palliative intent (4 months vs. 15 months,p< 0.01). Conclusions: Exploratory laparotomy in patients with peritoneal surface malignancies considered for CRS with HIPEC carries a substantial risk of complications. Improved preoperative staging using advanced technologies such as radiomics and laparoscopy is expected to reduce the number of patients undergoing nontherapeutic laparotomy.
背景：本研究旨在分析腹膜表面恶性肿瘤患者的发病率、死亡率及生存结局，这些患者最初被视为细胞减灭术联合腹腔热灌注化疗的候选者，但在探查性剖腹手术中被发现疾病无法切除，从而接受了非治疗性探查手术。患者与方法：我们评估了2008年1月至2022年12月期间转诊中心收治的腹膜表面恶性肿瘤患者数据。非治疗性剖腹手术后的不良事件依据美国国家癌症研究所不良事件通用术语标准4.0版进行分类。结果：在最初被视为细胞减灭术联合腹腔热灌注化疗候选者的486例腹膜表面恶性肿瘤患者中，46例（9.4%）因探查性剖腹手术中发现疾病无法切除而中止手术。无法切除的主要原因包括疾病广泛扩散（28例），其中13例发现小肠广泛受累。手术中位时长为90分钟（范围：60-180分钟）。10例患者（22%）出现术后并发症，死亡率为4.3%（2例）。未接受姑息性辅助全身化疗的患者生存期显著缩短（4个月 vs. 15个月，p<0.01）。结论：对于考虑接受细胞减灭术联合腹腔热灌注化疗的腹膜表面恶性肿瘤患者，探查性剖腹手术具有较高的并发症风险。通过影像组学、腹腔镜等先进技术改进术前分期，有望减少接受非治疗性剖腹手术的患者数量。
肿瘤(癌症)患者之家