已知在高容量中心进行多模式治疗可以优化消化道恶性肿瘤的治疗效果。然而，接受腹膜转移细胞减灭术（CRS）的患者通常需要在不同机构之间“分流”手术和全身治疗。我们推测这会对治疗效果产生不利影响。我们回顾性识别了2016年至2022年间在我们机构接受CRS治疗的结直肠或阑尾腺癌成年患者，并按照护理网络进行分组：‘协调护理’患者仅接受网络内的全身治疗，而‘分流护理’患者则部分接受外部网络提供的全身治疗。还确定与分流护理相关的因素。将两组患者间的CRS相关整体生存率（OS）和全身治疗相关严重不良事件（SAEs）进行比较。85例（80%）患者中，有47例（55%）为结直肠原发性肿瘤，51例（60%）接受分流护理。较长的行程距离[OR 1.01（CI 1.00-1.02），p = 0.02]和教育水平[OR 1.04（CI 1.01-1.07），p = 0.01]与接受分流护理相关。在结直肠[32.5个月对比40.8个月，HR 0.95（CI 0.43-2.10），p = 0.89]和阑尾[31.0个月对比27.4个月，HR 1.17（CI 0.37-3.74），p = 0.55]亚组中，接受分流和协调护理的患者的OS相当。严重不良事件的频率（7.8%对比17.6%，p = 0.19）也相似。基于全身治疗网络，生存率或严重不良事件没有显著差异。这表明在高容量中心接受CRS的患者可以在外部网络设施安全地接受全身治疗，并获得相似的结果。© 2023。外科肿瘤学会。

The delivery of multimodal treatment at a high-volume center is known to optimize the outcomes of gastrointestinal malignancies. However, patients undergoing cytoreductive surgery (CRS) for peritoneal metastases often must 'fragment' their surgical and systemic therapeutic care between different institutions. We hypothesized that this adversely affects outcomes.Adults undergoing CRS for colorectal or appendiceal adenocarcinoma at our institution between 2016 and 2022 were identified retrospectively and grouped by care network: 'coordinated care' patients received exclusively in-network systemic therapy, while 'fragmented care' patients received some systemic therapy from outside-network providers. Factors associated with fragmented care were also ascertained. Overall survival (OS) from CRS and systemic therapy-related serious adverse events (SAEs) were compared across the groups.Among 85 (80%) patients, 47 (55%) had colorectal primaries and 51 (60%) received fragmented care. Greater travel distance [OR 1.01 (CI 1.00-1.02), p = 0.02] and educational status [OR 1.04 (CI 1.01-1.07), p = 0.01] were associated with receiving fragmented care. OS was comparable between patients who received fragmented and coordinated care in the colorectal [32.5 months versus 40.8 months, HR 0.95 (CI 0.43-2.10), p = 0.89] and appendiceal [31.0 months versus 27.4 months, HR 1.17 (CI 0.37-3.74), p = 0.55] subgroups. The frequency of SAEs (7.8% versus 17.6%, p = 0.19) was also similar.There were no significant differences in survival or SAEs based on the networks of systemic therapy delivery. This suggests that patients undergoing CRS at a high-volume center may safely receive systemic therapy at outside-network facilities with comparable outcomes.© 2023. Society of Surgical Oncology.