Abstract：
BACKGROUND: The role of gastrectomy to achieve complete cytoreduction (CCR) for pseudomyxoma peritonei (PMP) is controversial due to uncertain risk/benefit ratio. The outcomes of patients who gastrectomy over a twenty-year period in a high-volume unit are reported.
METHODS: All patients requiring gastrectomy to achieve CCR for appendiceal PMP between 2000 and 2020 were reviewed. Demographics, disease, operative, complication, and survival data were analysed. The first and second decades were compared.
RESULTS: A total of 2148 patients underwent CRS and HIPEC, of which 78% had CCR. Gastrectomy was performed in 7.1%. Median age was 55 years, and 52% were female. Among gastrectomy patients, 94.2% had ≥1 elevated tumour marker, and 18% had high-grade disease. Median PCI was 30, and 30% required subtotal colectomy. Clavien-Dindo III-IV complications occurred in 32%, and 90-day mortality was 1.75%. Median survival was 104 months, and 10-year OS was 47%. Comparing the two decades, total CRS cases almost tripled, with a greater proportion achieving CCR (82.2% vs. 67.8%) but fewer requiring gastrectomy (5.3% vs. 13.5%). In those who had gastrectomy, disease was more advanced (higher PCI, more high-grade disease, more colectomies) in the later period. However, on multivariable analysis, there was no difference in survival between decades. High-grade histology was the only predictor of survival.
CONCLUSIONS: Gastrectomy can achieve good long-term survival with low mortality and acceptable morbidity and should not deter surgeons from achieving CCR. However, increasing experience shows CCR can be achieved, preserving the stomach in the majority of cases through careful consideration of the anatomy and gastric blood supply.
METHODS: All patients requiring gastrectomy to achieve CCR for appendiceal PMP between 2000 and 2020 were reviewed. Demographics, disease, operative, complication, and survival data were analysed. The first and second decades were compared.
RESULTS: A total of 2148 patients underwent CRS and HIPEC, of which 78% had CCR. Gastrectomy was performed in 7.1%. Median age was 55 years, and 52% were female. Among gastrectomy patients, 94.2% had ≥1 elevated tumour marker, and 18% had high-grade disease. Median PCI was 30, and 30% required subtotal colectomy. Clavien-Dindo III-IV complications occurred in 32%, and 90-day mortality was 1.75%. Median survival was 104 months, and 10-year OS was 47%. Comparing the two decades, total CRS cases almost tripled, with a greater proportion achieving CCR (82.2% vs. 67.8%) but fewer requiring gastrectomy (5.3% vs. 13.5%). In those who had gastrectomy, disease was more advanced (higher PCI, more high-grade disease, more colectomies) in the later period. However, on multivariable analysis, there was no difference in survival between decades. High-grade histology was the only predictor of survival.
CONCLUSIONS: Gastrectomy can achieve good long-term survival with low mortality and acceptable morbidity and should not deter surgeons from achieving CCR. However, increasing experience shows CCR can be achieved, preserving the stomach in the majority of cases through careful consideration of the anatomy and gastric blood supply.
摘要：
背景：由于不确定的风险/收益比，胃切除术对腹膜假性黏液瘤（PMP）实现完全细胞减灭术（CCR）的作用存在争议。报告了在大批量单位进行胃切除术20年的患者的结果。
方法：回顾了2000年至2020年间所有需要胃切除术以实现阑尾PMPCCR的患者。人口统计,疾病,Operative,并发症,和生存数据进行了分析。比较了第一个和第二个十年。
结果：共有2148名患者接受了CRS和HIPEC，其中78%有CCR。进行胃切除术的比例为7.1%。中位年龄为55岁,52%是女性。在胃切除术患者中，94.2%有≥1个肿瘤标志物升高，18%患有高级别疾病。中位PCI为30，30%需要结肠次全切除术。Clavien-DindoIII-IV并发症发生率为32％，90天死亡率为1.75%。中位生存期为104个月,10年OS为47%。比较这二十年，CRS病例总数几乎增加了两倍，实现CCR的比例更高(82.2%与67.8%），但需要胃切除术的人较少（5.3%vs.13.5%）。那些做了胃切除术的人,疾病更晚期(PCI越高，高级别疾病越多，更多的结肠切除术)。然而,在多变量分析中，几十年之间的生存率没有差异。高级别组织学是生存的唯一预测因子。
结论：胃切除术可以获得良好的长期生存率，死亡率低，发病率可接受，并且不应阻碍外科医生实现CCR。然而,越来越多的经验表明CCR是可以实现的，在大多数情况下，通过仔细考虑解剖结构和胃血液供应来保留胃。
方法：回顾了2000年至2020年间所有需要胃切除术以实现阑尾PMPCCR的患者。人口统计,疾病,Operative,并发症,和生存数据进行了分析。比较了第一个和第二个十年。
结果：共有2148名患者接受了CRS和HIPEC，其中78%有CCR。进行胃切除术的比例为7.1%。中位年龄为55岁,52%是女性。在胃切除术患者中，94.2%有≥1个肿瘤标志物升高，18%患有高级别疾病。中位PCI为30，30%需要结肠次全切除术。Clavien-DindoIII-IV并发症发生率为32％，90天死亡率为1.75%。中位生存期为104个月,10年OS为47%。比较这二十年，CRS病例总数几乎增加了两倍，实现CCR的比例更高(82.2%与67.8%），但需要胃切除术的人较少（5.3%vs.13.5%）。那些做了胃切除术的人,疾病更晚期(PCI越高，高级别疾病越多，更多的结肠切除术)。然而,在多变量分析中，几十年之间的生存率没有差异。高级别组织学是生存的唯一预测因子。
结论：胃切除术可以获得良好的长期生存率，死亡率低，发病率可接受，并且不应阻碍外科医生实现CCR。然而,越来越多的经验表明CCR是可以实现的，在大多数情况下，通过仔细考虑解剖结构和胃血液供应来保留胃。
