Abstract：
BACKGROUND: The combination of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) constitutes the established standard of care for pseudomyxoma peritonei patients. However, the role of HIPEC lacks validation through randomized trials, leading to diverse proposed treatment protocols. This consensus seeks to standardize HIPEC regimens and identify research priorities for enhanced clarity.
METHODS: The steering committee applied the patient, intervention, comparator, and outcome method to formulate crucial clinical questions. Evaluation of evidence followed the Grading of Recommendations, Assessment, Development, and Evaluation system. Consensus on HIPEC regimens and research priorities was sought through a two-round Delphi process involving international experts.
RESULTS: Out of 90 eligible panelists, 71 (79%) participated in both Delphi rounds, resulting in a consensus on six out of seven questions related to HIPEC regimens. An overwhelming 84% positive consensus favored combining HIPEC with CRS, while a 70% weak positive consensus supported HIPEC after incomplete CRS. Specific HIPEC regimens also gained consensus, with 53% supporting Oxaliplatin 200 mg/m2 and 51% favoring the combination of cisplatin (CDDP) associated with mitomycin-C (MMC). High-dose MMC regimens received an 89% positive recommendation. In terms of research priorities, 61% of panelists highlighted the importance of studies comparing HIPEC regimens post CRS. The preferred regimens for such studies were the combination of CDDP/MMC and high-dose MMC.
CONCLUSIONS: The consensus recommends the application of HIPEC following CRS based on the available evidence. The combination of CDDP/MMC and high-dose MMC regimens are endorsed for both current clinical practice and future research efforts.
METHODS: The steering committee applied the patient, intervention, comparator, and outcome method to formulate crucial clinical questions. Evaluation of evidence followed the Grading of Recommendations, Assessment, Development, and Evaluation system. Consensus on HIPEC regimens and research priorities was sought through a two-round Delphi process involving international experts.
RESULTS: Out of 90 eligible panelists, 71 (79%) participated in both Delphi rounds, resulting in a consensus on six out of seven questions related to HIPEC regimens. An overwhelming 84% positive consensus favored combining HIPEC with CRS, while a 70% weak positive consensus supported HIPEC after incomplete CRS. Specific HIPEC regimens also gained consensus, with 53% supporting Oxaliplatin 200 mg/m2 and 51% favoring the combination of cisplatin (CDDP) associated with mitomycin-C (MMC). High-dose MMC regimens received an 89% positive recommendation. In terms of research priorities, 61% of panelists highlighted the importance of studies comparing HIPEC regimens post CRS. The preferred regimens for such studies were the combination of CDDP/MMC and high-dose MMC.
CONCLUSIONS: The consensus recommends the application of HIPEC following CRS based on the available evidence. The combination of CDDP/MMC and high-dose MMC regimens are endorsed for both current clinical practice and future research efforts.
摘要：
背景：细胞减灭术（CRS）和腹腔热化疗（HIPEC）的组合构成了腹膜假性黏液瘤患者的既定护理标准。然而,HIPEC的作用缺乏通过随机试验的验证，导致不同的治疗方案。这一共识旨在使HIPEC方案标准化，并确定研究重点，以提高清晰度。
方法：指导委员会将患者，干预，比较器,和结果方法来制定关键的临床问题。对证据的评估遵循建议的分级，评估,发展,和评价体系。通过有国际专家参与的两轮德尔菲进程，寻求就HIPEC方案和研究优先事项达成共识。
结果：在90名合格的小组成员中，71人(79%)参加了德尔福两轮比赛，在与HIPEC方案相关的7个问题中的6个问题上达成共识。压倒性的84％积极共识赞成将HIPEC与CRS结合使用，而在CRS不完整后，70%的微弱积极共识支持HIPEC。具体的HIPEC方案也获得了共识，53%支持奥沙利铂200mg/m2，51%支持顺铂（CDDP）与丝裂霉素-C（MMC）联合使用。高剂量MMC方案获得了89%的阳性推荐。在研究重点方面,61%的小组成员强调了比较CRS后HIPEC方案的研究的重要性。此类研究的优选方案是CDDP/MMC和高剂量MMC的组合。
结论：根据现有证据，共识建议在CRS之后应用HIPEC。CDDP/MMC和大剂量MMC方案的组合在当前的临床实践和未来的研究工作中得到认可。
方法：指导委员会将患者，干预，比较器,和结果方法来制定关键的临床问题。对证据的评估遵循建议的分级，评估,发展,和评价体系。通过有国际专家参与的两轮德尔菲进程，寻求就HIPEC方案和研究优先事项达成共识。
结果：在90名合格的小组成员中，71人(79%)参加了德尔福两轮比赛，在与HIPEC方案相关的7个问题中的6个问题上达成共识。压倒性的84％积极共识赞成将HIPEC与CRS结合使用，而在CRS不完整后，70%的微弱积极共识支持HIPEC。具体的HIPEC方案也获得了共识，53%支持奥沙利铂200mg/m2，51%支持顺铂（CDDP）与丝裂霉素-C（MMC）联合使用。高剂量MMC方案获得了89%的阳性推荐。在研究重点方面,61%的小组成员强调了比较CRS后HIPEC方案的研究的重要性。此类研究的优选方案是CDDP/MMC和高剂量MMC的组合。
结论：根据现有证据，共识建议在CRS之后应用HIPEC。CDDP/MMC和大剂量MMC方案的组合在当前的临床实践和未来的研究工作中得到认可。
