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開催概要
開催回
第58回・2020年・京都
 

腹膜切除術後の合併症が予後に及ぼす影響

演題番号 : WS18-6

[筆頭演者]
鍛 利幸:1 
[共同演者]
宮内 雄也:1、稲本 道:1、高木 秀和:1、宇山 直樹:1

1:市立岸和田市民病院・消化器外科

 

Purposes:
Cytoreductive surgery and hyperthermic intraperitoneal carcinomatosis (CRS+HIPEC) has emerged as active treatment for selected patients with peritoneal carcinomatosis, especially of appendiceal cancer. The purpose of this study is to investigate the influence of postoperative complication on the prognosis.
Methods:
Data of 62 patients with peritoneal carcinomatosis of appendiceal origin undergoing CRS+HIPEC from 1999 to 2019 were retrieved. Prognostic factors associated with overall survival (OS) were analyzed using cox-proportional hazard model.
Results:
Postoperative complication (G3-5) was observed in 17 cases (32.6%). Median OS was 159 months, and 5-year and 10-year OS rates were 64.0% and 50.2%, respectively. PS (2/3), PCI (>28), CC (2/3), complication (G3-5) and histological grade (sig+ca.) were significantly associated with poor prognosis by univariate analysis. PS (RR=3.56), complication (RR=2.92) and histological grade (RR=3.36) remained significant after multivariate analysis. When complication was divided into medical complication and surgical complication, only medical one was significantly associated with worse OS (RR=8.48). Medical complication was more frequently observed in elderly patients (age>70) than in young patients (26% vs. 2.5%, p=0.012), and postoperative complication was more significantly prognostic in elderly patients (p=0.008) than in young patients (p=0.093). While incidence rate of surgical complication significantly decreased from 26% in the earlier period to 6% in the later period (p=0.038), medical complication slightly changed from 13% to 10%.
Conclusions:
Postoperative complication was independent factor associated with worse OS after CRS+HIPEC. Medical complication was more important for improving the prognosis than surgical complication, but the management was difficult.

キーワード

臓器別:大腸・小腸

手法別:集学的治療

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