Extensive Cytoreductive Surgery for Appendiceal Carcinomatosis: Morbidity, Mortality, and Survival

Abstract

Background Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemoperfusion (HIPEC) are frequently used to treat appendiceal carcinomatosis. Some patients require multivisceral resection because of the volume of disease. It is unclear whether extent of CRS impacts survival in appendiceal carcinomatosis. Methods We analyzed 282 patients undergoing attempted CRS/HIPEC for appendiceal carcinomatosis. Patients were defined as having undergone Extensive CRS (n = 60) if they had >3 organ resections or >2 anastomoses; a subgroup of Extreme CRS patients (n = 10) had ≥5 organ resections and ≥3 anastomoses. Kaplan–Meier survival curves and multivariate Cox-regression models were used to identify prognostic factors affecting outcomes. Results Relative to the comparison group, patients undergoing Extensive CRS had a higher median peritoneal carcinomatosis index, operative duration, blood loss, and length of stay. No difference in completeness of cytoreduction, severe morbidity, or 60-day mortality was evident. Subgroup analysis of 10 patients undergoing extreme CRS likewise revealed no increase in severe morbidity or mortality. Median progression-free (PFS) and overall survival (OS) were 23.5 and 74 months in the comparison group; 18.5 (p = 0.086) and 51 (p = 0.85) months in the Extensive CRS group; and 40 months and not reached in the Extreme CRS subgroup. In a multivariable analysis, extent of CRS was not independently associated with PFS or OS. Conclusions Extensive CRS is associated with greater OR time, blood loss, and length of stay, but is not associated with higher morbidity, mortality, or inferior oncologic outcomes in patients with appendiceal carcinomatosis.

Extreme cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: Outcomes from a single tertiary center

“…Moreover, we found a correlation between multi-organ resection and higher incidence of perioperative morbidity by univariate analysis, contrary to the findings in previous similar studies [15,16]. Overall and major morbidity rates (74% and 34% respectively) in the extreme group were significantly higher, but still comparable to those reported by Gusani and colleagues, who compared morbidity outcomes from 15 centers and reported overall and major morbidity rates of 30e74.2% and 12e66%, respectively [21].…”

“…Similar to the results of another study that examined the effect of extensive CRS/HIPEC procedures in patients with appendiceal neoplasms [16], our findings demonstrate that extreme CRS/HIPEC procedures are associated with longer duration of surgery, longer hospital stay and increased blood transfusion requirements. Moreover, we found a correlation between multi-organ resection and higher incidence of perioperative morbidity by univariate analysis, contrary to the findings in previous similar studies [15,16].…”

“…However, there is a paucity of published literature on the impact of multivisceral resection as part of CRS/HIPEC procedures on shortand long-term outcomes. In the few studies that have directly addressed this issue [15,16], multivisceral resection was not found to correlate with perioperative morbidity, mortality or oncologic outcomes.…”

Long-Term Outcomes after Surgery for Appendiceal Mucinous Tumours

“…The main goal of PMP treatment is the prevention of locoregional recurrence rather than systemic disease. Wagner et al [22] retrospectively analysed 282 patients undergoing CRS and HIPEC. They concluded that the extent of CRS does not affect the morbidity but prolongs the survival [22].…”

“…Wagner et al [22] retrospectively analysed 282 patients undergoing CRS and HIPEC. They concluded that the extent of CRS does not affect the morbidity but prolongs the survival [22]. Recently a large multicentre retrospective study by Chua et al [23] with more than 2,000 patients with PMP was published.…”