Prophylactic hyperthermic intraperitoneal chemotherapy in patients with epithelial appendiceal neoplasms

Abstract

Background Prophylactic hyperthermic intraperitoneal chemotherapy (HIPEC) is a promising approach for preventing peritoneal carcinomatosis in high-risk patients. We report our initial experience with prophylactic HIPEC in a series of patients with appendiceal neoplasms. Methods We retrospectively reviewed our prospectively maintained database to identify patients who underwent HIPEC in the absence of peritoneal disease. Patients with previously documented peritoneal surface disease were excluded. Data regarding clinical, operative and pathological features were analysed. Results Out of 322 HIPEC procedures performed between March 2007and August 2015, we identified 16 patients who underwent surgery with prophylactic intent. Primary diagnoses included high-grade and low-grade appendiceal neoplasms. Most patients presented originally with appendiceal perforation; all patients underwent initial surgery during which the appendix or right colon were resected. Following a median time interval of 2.2 months, a second surgery performed at our institution consisted of completion of omentectomy, partial colectomy and oophorectomy, with administration of prophylactic HIPEC (using mitomycin C). A totally laparoscopic approach was attempted and achieved in 11 patients in whom the median duration of surgery, estimated intraoperative blood loss and length of hospitalisation were 251 min, 100 cm(3) and 4 days, respectively. There were no cases of major perioperative morbidity or mortality. Conclusions Prophylactic HIPEC for appendiceal neoplasms is feasible, safe and may be performed laparoscopically. Larger studies with long-term follow-up are needed to determine whether a survival benefit is associated with this treatment.

Intraperitoneal Chemotherapy for Peritoneal Metastases: Technical Innovations, Preclinical and Clinical Advances and Future Perspectives

“…Secondly, in a curative way, it aims to perform CRS and HIPEC for patients with limited PC [ 48 ]. Finally, it can lead to palliative [ 49 ] or prophylactic [ 50 ] HIPEC.…”

Prophylactic Hyperthermic Intraperitoneal Chemotherapy for Patients at High Risk of Developing Gallbladder Cancer Peritoneal Metastases: Case Report and Rationale for a Prospective Clinical Trial

“…The goal of HIPEC in the prophylactic setting is to treat microscopic peritoneal implants, thereby limiting the risk of peritoneal recurrence and improving patient outcomes after oncologic resection. The strategy of prophylactic HIPEC has been explored or is under active investigation for numerous gastrointestinal malignancies, including colon, gastric, and appendiceal cancers [3][4][5][6][7][8]. For example, building on the promising foundations set by cohort studies, many phase III RCTs studying prophylactic HIPEC in patients with colon cancer have recently been published, with several more currently being conducted (examples of active clinical trials: NCT02965248, NCT03914820, NCT04370925, NCT02974556) [5,7,8,48].…”

“…The concept of prophylactic heated intraperitoneal chemotherapy (HIPEC) as a treatment for preventing peritoneal recurrence has been introduced and studied over the past decade. Initial results from randomized controlled trials (RCTs) in more prevalent gastrointestinal (GI) malignancies call for cautious optimism in this strategy as part of a multimodal treatment sequence [3][4][5][6][7][8]. Therapeutic HIPEC in GBC patients with macroscopic peritoneal disease undergoing cytoreductive surgery (CRS) has been associated with a survival advantage in a multi-institutional retrospective case series [9].…”

Laparoscopic hyperthermic intraperitoneal chemotherapy for appendiceal tumors

“…8 Second-look exploration with prophylactic HIPEC in a selected group of patients with resected lowgrade appendiceal tumors at risk of peritoneal relapse has been proposed. [9][10][11] Laparoscopy could be the ideal means for a HIPEC delivery protocol to treat patients with LAMN at high risk of peritoneal failure. 9 However, because of the relative rarity of PMP, a second-look strategy is impossible to investigate within a prospective comparative trial.…”

“…Prophylactic HIPEC to complete second‐look surgery has been tested as an adjuvant treatment in colorectal cancer patients at risk of peritoneal recurrence . Second‐look exploration with prophylactic HIPEC in a selected group of patients with resected low‐grade appendiceal tumors at risk of peritoneal relapse has been proposed . Laparoscopy could be the ideal means for a HIPEC delivery protocol to treat patients with LAMN at high risk of peritoneal failure .…”