T4期结直肠癌根治术后早期腹腔热灌注化疗的临床研究

目的:探讨T4期结直肠癌患者根治术后早期行腹腔热灌注化疗(HIPEC)的可行性、安全性及短期临床疗效。方法:回顾性分析2011年1月—2013年6月收治的96例T4期结直肠癌患者资料,其中48例于术后第5~6天开始行HIPEC(1次/d,共3次),术后1个月内行第1次m FOLFOX6方案全身静脉化疗,共6疗程(HIPEC组);另48例仅行相同方案的全身静脉化疗(对照组)。比较两组患者的不良反应、并发症、术后1、2年复发率、生存率及生存质量情况。结果:HIPEC及全身静脉化疗均顺利完成;两组均无手术相关死亡,均未出现切口感染、吻合口瘘、粘连性肠梗阻等并发症。两组患者骨髓抑制、恶心呕吐、肝功能损害差异均无统计学意义(均P0.05);HIPEC组术后1、2年复发率均低于对照组(2.1%vs.20.8%;6.3%vs.31.3%,均P0.05);两组术后1年生存率差异无统计学意义(P0.05);HIPEC组术后2年生存率高于对照组(81.3%vs.58.3%,P0.05);HIPEC组生存质量评分升高比例明显高于对照组(75.0%vs.25.0%,P0.05)。HIPEC组中,结肠癌患者的中位生存时间长于直肠癌患者(32个月vs.18个月,P0.05)。结论:T4期结直肠癌患者根治术后早期行HIPEC可有效控制腹腔复发、转移,提高患者近期生存率及生存质量,无明显毒副作用,安全可行。

Clinical analysis of early hyperthermic intraperitoneal chemotherapy after radical resection of T4 colorectal cancer

Objective: To investigate the feasibility, safety and short-term clinical efficacy of early hyperthermic intraperitoneal chemotherapy (HIPEC) after radical resection of T4 colorectal cancer. Methods: The clinical data of 96 patients with T4 colorectal cancer treated from January 2011 to June 2013 were retrospectively analyzed. Of the patients, 48 cases began to receive HIPEC from postoperative day 5 or 6 (once daily for a total of 3 sessions), and then underwent the first systemic infusion of mFOLFOX6 regimen within postoperative one month, for a total of 6 cycles (HIPEC group), and another 48 cases only underwent systemic chemotherapy of the same regimen (control group). The incidence of adverse effects and complications, and the 1- and 2-year recurrence and survival rate as well as the quality of life of the two groups of patients were compared. Results: HIPEC and systemic chemotherapy were all successfully performed. There were no surgical deaths or complications such as incisional wound infection, anastomotic leakage and adhesion intestinal obstruction in either group. There were no significant differences in incidence of myelosuppression, nausea, vomiting and liver dysfunction between the two groups (all P>0.05). The 1- and 2-year recurrence rate in HIPEC group were significantly lower than those in control group (2.1% vs. 20.8%; 6.3% vs. 31.3%, P<0.05). There was no difference in 1-year survival rate between the two groups (P>0.05), but the 2-year survival rate was significantly higher in HIPEC group than that in control group (81.3% vs. 58.3%, P<0.05). The ratio of patients with increased score of quality of life in HIPEC group was significantly higher than that in control group (75.0% vs. 25.0%, P<0.05). In HIPEC group, the median survival time of patients with colon cancer was significantly longer than that of patients with rectal cancer (32 months vs. 18 months, P<0.05). Conclusion: Early postoperative HIPEC for T4 colorectal cancer following radical resection is safe and feasible. It can effectively reduce peritoneal recurrence and metastasis, improve the short-term survival and quality of life of the patients, and has no obvious adverse effects.