METHODS: Data from CRPM patients treated with CRS alone between 2013 and 2020 in France were collected through a national medical database. The study used a cutoff value of the annual CRS-alone caseload affecting the 90-day postoperative mortality (POM) determined from our previous study to define low-volume (LV) HIPEC and high-volume (HV) HIPEC centers. Perioperative outcomes were compared between no-HIPEC, LV-HIPEC, and HV-HIPEC centers. The trend between years and HIPEC rates was analyzed using the Cochrane-Armitage test.
RESULTS: Data from 4159 procedures were analyzed. The patients treated in no-HIPEC and LV-HIPEC centers were older compared with HV-HIPEC centers (p < 0.0001) and had a higher Elixhauser comorbidity index (p < 0.0001) and less complex surgery (p < 0.0001). Whereas the major morbidity (MM) rate did not differ between groups (p = 0.79), the 90-day POM was lower in HV-HIPEC centers than in no-HIPEC and LV-HIPEC centers (5.4% vs 15% and 13.3%; p < 0.0001), with lower failure-to-rescue (FTR) (p < 0.0001). After P7, the CRS/HIPEC rate decreased drastically in Cancer centers (p < 0.001), whereas patients treated with CRS alone are still referred to expert centers.
CONCLUSIONS: Centralization of CRS alone should improve patient selection as well as FTR and POM. After P7, CRS/HIPEC decreased mostly in Cancer centers, without any impact on the number of CRS-alone cases referred to expert centers.
方法:通过国家医学数据库收集了法国2013年至2020年间仅接受CRS治疗的CRPM患者的数据。该研究使用了影响我们先前研究确定的90天术后死亡率(POM)的年度CRS单独病例量的临界值,以定义低容量(LV)HIPEC和高容量(HV)HIPEC中心。围手术期结果比较无HIPEC,LV-HIPEC,和HV-HIPEC中心。使用Cochrane-Armitage检验分析了年份和HIPEC比率之间的趋势。
结果:分析了来自4159个程序的数据。与HV-HIPEC中心相比,在非HIPEC和LV-HIPEC中心治疗的患者年龄较大(p<0.0001),并且Elixhauser合并症指数较高(p<0.0001),手术复杂性较低(p<0.0001)。而主要发病率(MM)率在组间没有差异(p=0.79),HV-HIPEC中心的90天POM低于无HIPEC和LV-HIPEC中心(5.4%vs15%和13.3%;p<0.0001),较低的抢救失败(FTR)(p<0.0001)。P7后,癌症中心的CRS/HIPEC率急剧下降(p<0.001),而仅接受CRS治疗的患者仍转诊至专家中心。
结论:单独集中CRS可以改善患者选择以及FTR和POM。P7后,CRS/HIPEC主要在癌症中心下降,对提交专家中心的单独CRS病例数量没有任何影响。