Right hemicolectomy does not confer a survival advantage in patients with mucinous carcinoma of the appendix and peritoneal seeding

Abstract

Right hemicolectomy does not confer a survival advantage in patients with mucinous appendiceal tumours with peritoneal seeding. These data suggest that right hemicolectomy should be avoided unless metastatic involvement of the appendiceal or distal ileocolic lymph nodes is documented by biopsy, or the resection margin is inadequate.

Mucinous epithelial neoplasms of the appendix and pseudomyxoma peritonei

“…Using this aggressive approach, they achieved 5-and 10-year survival rates of 71.9 and 54.5%. 46 Other groups have reported similar survival rates using cytoreduction surgery and HIPEC. In particular, long-term survival is noted to be better in some studies.…”

“…Right hemicolectomy offers no additional benefit over appendectomy alone for these patients and is probably best done by a surgeon with expertise in the management of peritoneal malignancy who can arrange definitive cytoreductive surgery if necessary. 46,47 Tumors that have disseminated widely throughout the peritoneal cavity were treated historically by debulking but, more recently, with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC; see PMP).…”

“…Mucinous adenocarcinomas may not only rupture and metastasize to the peritoneum, 59,62 but can also spread via a hematogenous route. 7,46,53,64 Grossly, peritoneal metastases may resemble those that occur in LAMNs. Histologically, the peritoneal tumor is usually more cellular, and the neoplastic epithelium shows a greater degree of architectural complexity and higher-grade cytologic atypia, desmoplastic stroma, and possibly signet ring cells (see PMP).…”

“…Patients whose tumors are resectable should be treated aggressively with peritonectomy and post-operative intraperitoneal chemotherapy (see PMP). 46,70,71 Pseudomyxoma peritonei PMP refers to the accumulation of mucin within the peritoneal cavity secondary to mucinous epithelial neoplasia (Figure 2). This most often occurs because of peritoneal spread of a mucinous neoplasm from the appendix but has been described with mucinous tumors from other sites, including colon, ovary, gallbladder, pancreas, and urachus.…”

“…81,82 Survival rates for patients who underwent debulking were reported to be 86%, 53-67%, and 32% at 2, 5, and 10 years, respectively. 81,83 Sugarbaker and colleagues 46,70,71,84 pioneered an aggressive treatment approach that involves peritonectomies in order to achieve complete cytoreduction and HIPEC. The cytoreduction procedure includes peritonectomies as well as resection of affected organs.…”