Abstract：
BACKGROUND: Addition of oxaliplatin-based hyperthermic intraperitoneal chemotherapy (HIPEC) to cytoreductive surgery (CRS) in the treatment of peritoneal metastases of colorectal origin (CRPM) did not show any survival benefit in the PRODIGE 7 trial (P7). This study aimed to investigate whether perioperative outcomes after CRS alone for CRPM patients is mediated by hospital volume and to determine the effect of P7 on French practice for CRPM patients treated respectively with CRS alone and CRS/HIPEC.
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.
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.
摘要：
背景：在肿瘤细胞减灭术（CRS）治疗结直肠腹膜转移（CRPM）的基础上，以奥沙利铂为基础的腹腔热化疗（HIPEC）在PRODIGE7试验（P7）中未显示任何生存益处。本研究旨在调查CRPM患者单独使用CRS后的围手术期结局是否由医院容量介导，并确定P7对分别使用CRS和CRS/HIPEC治疗的CRPM患者的法国实践的影响。
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。
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。
