Outcomes from cytoreduction and hyperthermic intraperitoneal chemotherapy for appendiceal epithelial neoplasms

Abstract

Background: Appendiceal epithelial neoplasms are rare cancers. Management of peritoneal disease from appendiceal neoplasms has historically been with debulking surgery. In recent decades, the advent of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has become the standard of care. Here, we report our single institution 10-year experience with CRS and HIPEC for appendiceal neoplasms. Methods: This is a retrospective review from 1 January 2008 to 1 June 2017 of all patients undergoing CRS and HIPEC for appendiceal neoplasms. Institutional ethics approval was granted for this project. Results: One hundred and seventy-two patients underwent 208 CRSs during this time. Overall, 83.72% of patients had one CRS and HIPEC procedure. Pseudomyxoma peritonei from a perforated appendiceal mucinous neoplasm accounted for 67.9% of cases. The median peritoneal carcinomatosis index (PCI) was 14, with complete cytoreduction achieved in 74.2% of patients. Fifty-four percent of patients had at least one complication, with one (0.5%) peri-operative mortality in our cohort. For the entire cohort, the median overall survival was 104 months and a 5-year survival of 75%. In those having a complete cytoreduction, 5-year survival was 90%, with a median disease free interval of 63 months. PCI and completeness of cytoreduction were independent predictors of overall survival. Conclusion: Our results demonstrate that CRS and HIPEC for appendiceal neoplasms are safe and effective. Despite carrying some morbidity, it offers patients an excellent disease free and overall survival.

The Prognostic Impact of Pathology on Patients With Pseudomyxoma Peritonei Undergoing Debulking Surgery: A Systematic Review and Meta-Analysis of Retrospective Studies

“…Sugarbaker et al (8) first introduced complete cytoreductive surgery (CRS) plus heated intraoperative intraperitoneal chemotherapy (HIPEC), which provided new ideas for PMP treatment and has been suggested as the standard therapy (9). However, a portion of patients (16.5-25.8%) (10,11) were no longer suitable for radical surgery at the time of diagnosis due to the huge burden of PMP; for example, the massive disease invades the first porta hepatis or the caudate lobe, which is difficult to be cleaned, and the proximal third of the stomach and small bowel are involved, which would lead the length of the remnant intestines to be shorter than 2 m. For these patients, who represent a group with highly advanced PMP, the next best choice is debulking surgery (12). The definition of debulking surgery is a surgical technique that is done when the macroscopic tumor in the abdominal cavity cannot be removed.…”

Is omentectomy necessary in the treatment of benign or malignant abdominal pathologies? A systematic review

“…PMP is seen in 9% of low-grade tumors, and it is reported that PMP develops in 67.9% of perforated mucinous neoplasms. CRS and hyperthermic intraperitoneal chemotherapy are also recommended for appendiceal neoplasms[ 33 , 34 ].…”

Outcomes of neoadjuvant chemotherapy before CRS‐HIPEC for patients with appendiceal cancer

“…Recurrence rates are high even when complete cytoreduction (CC‐0) can be achieved 9 . CRS‐HIPEC are major operations associated with significant postoperative morbidity, delaying the receipt of adjuvant chemotherapy when indicated 11 . For these reasons, the use of systemic chemotherapy before CRS‐HIPEC has long been of interest to investigators.…”