Background:Peritoneal surface malignancies (PSM) are aggressive cancers with limited treatment access in low- and middle-income countries (LMICs). While cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have improved survival outcomes globally, their feasibility in LMICs remains underexplored. This first multicenter study in North Africa evaluates the implementation and outcomes of CRS with or without HIPEC in resource-limited settings.Methods:A retrospective cohort study of 391 patients with PSM (colorectal cancer, pseudomyxoma peritonei, ovarian cancer, gastric cancer, or mesothelioma) treated with CRS ± HIPEC between 2014 and 2020 at four tertiary centers in Morocco, Tunisia, and Algeria. Primary outcomes included overall survival (OS), disease-free survival (DFS), and severe postoperative morbidity (Clavien-Dindo ≥ IIIa). Cox regression was used to identify independent prognostic factors.Results:Among 391 patients, complete cytoreduction (CC-0/1) was achieved in 88%, and HIPEC was performed in 39%. Severe morbidity occurred in 22%, with HIPEC, spleno-pancreatectomy, and incomplete cytoreduction (CC-2) identified as significant risk factors. The median OS was 68 months, with 1- and 5-year survival rates of 97% and 56%, respectively. Patients undergoing CRS + HIPEC had significantly longer OS than CRS alone (70 vs. 64 months,p= 0.016), though DFS was not significantly different between groups. Independent predictors of improved OS included HIPEC, CC score, PCI, and primary tumor type.Conclusions:This first North African multicenter study establishes the feasibility and efficacy of CRS and HIPEC in LMICs, achieving survival outcomes comparable to high-income settings. The findings support expanding advanced PSM treatment programs in resource-limited settings, emphasizing structured training and multidisciplinary collaboration to improve access and outcomes.
背景：腹膜表面恶性肿瘤（PSM）是一种侵袭性癌症，在中低收入国家（LMICs）的治疗手段有限。尽管肿瘤细胞减灭术（CRS）联合腹腔热灌注化疗（HIPEC）在全球范围内改善了患者的生存结局，但其在LMICs的可行性仍待深入探索。这项北非地区的首次多中心研究评估了在资源有限环境下实施CRS联合或不联合HIPEC的效果及临床结局。 方法：本研究回顾性分析了2014年至2020年间在摩洛哥、突尼斯和阿尔及利亚的四家三级医疗中心接受CRS±HIPEC治疗的391例PSM患者（包括结直肠癌、腹膜假黏液瘤、卵巢癌、胃癌或间皮瘤）。主要结局指标包括总生存期（OS）、无病生存期（DFS）及严重术后并发症（Clavien-Dindo分级≥IIIa）。采用Cox回归分析确定独立的预后因素。 结果：在391例患者中，88%实现了完全肿瘤细胞减灭（CC-0/1），39%接受了HIPEC治疗。严重并发症发生率为22%，其中HIPEC、脾胰切除术及不完全肿瘤减灭（CC-2）是重要的风险因素。中位OS为68个月，1年及5年生存率分别为97%和56%。接受CRS+HIPEC治疗的患者OS显著长于仅接受CRS者（70个月 vs. 64个月，p=0.016），但两组间DFS无显著差异。改善OS的独立预测因素包括HIPEC治疗、CC评分、腹膜癌指数（PCI）及原发肿瘤类型。 结论：这项北非地区首次多中心研究证实了CRS与HIPEC在LMICs的可行性和有效性，其生存结局与高收入国家相当。研究结果支持在资源有限地区推广先进的PSM治疗方案，并强调通过系统化培训和多学科协作以提高治疗可及性和临床结局。
肿瘤(癌症)患者之家