Outcomes of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemoperfusion in Patients with High-Grade, High-Volume Disseminated Mucinous Appendiceal Neoplasms.

Abstract

BACKGROUND:

High-grade (HG) mucinous appendiceal neoplasms (MAN) have a worse prognosis than low-grade histology. Our objective was to assess the safety and efficacy of cytoreductive surgery with hyperthermic intraperitoneal chemoperfusion (CRS/HIPEC) in patients with high-grade, high-volume (HG-HV) peritoneal metastases in whom the utility of this aggressive approach is controversial.

METHODS:

Prospectively collected perioperative data were compared between patients with peritoneal metastases from HG-HV MAN, defined as simplified peritoneal cancer index (SPCI) ≥12, and those with high-grade, low-volume (HG-LV; SPCI <12) disease. Kaplan-Meier curves and multivariate Cox regression models identified prognostic factors affecting oncologic outcomes.

RESULTS:

Overall, 54 patients with HG-HV and 43 with HG-LV peritoneal metastases underwent CRS/HIPEC. The HG-HV group had longer operative time, increased blood loss/transfusion, and increased intensive care unit length of stay (p < 0.05). Incomplete macroscopic cytoreduction (CC-1/2/3) was higher in the HG-HV group compared with the HG-LV group (68.5 vs. 32.6 %; p = 0.005). Patients with HG-HV disease demonstrated worse survival than those with HG-LV disease (overall survival [OS] 17 vs. 42 m, p = 0.009; time to progression (TTP) 10 vs. 14 m, p = 0.024). However, when complete macroscopic resection (CC-0) was achieved, the OS and progression-free survival of patients with HG-HV disease were comparable with HG-LV disease (OS 56 vs. 52 m, p = 0.728; TTP 20 vs. 19 m, p = 0.393). In a multivariate Cox proportional hazard regression model, CC-0 resection was the only significant predictor of improved survival for patients with HG-HV disease.

CONCLUSIONS:

Although patients with HG-HV peritoneal metastases from MAN have worse prognosis compared with patients with HG-LV disease, their survival is comparable when complete macroscopic cytoreduction is achieved.

• Authors: Patricio M Polanco, Ying Ding, Jordan M Knox, Lekshmi Ramalingam, Heather Jones, Melissa E Hogg, Amer H Zureikat, Matthew P Holtzman, James Pingpank, Steven Ahrendt, Herbert J Zeh, David L Bartlett, Haroon A Choudry
• Journal: Annals of surgical oncology (Ann Surg Oncol) Vol. 23 Issue 2 Pg. 382-90 (Feb 2016) ISSN: 1534-4681 [Electronic] United States
• PMID: 26429720 (Publication Type: Journal Article)

Topics

• Adenocarcinoma, Mucinous (mortality, secondary, therapy)
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Appendiceal Neoplasms (mortality, pathology, therapy)
• Chemotherapy, Cancer, Regional Perfusion
• Combined Modality Therapy
• Cytoreduction Surgical Procedures
• Female
• Follow-Up Studies
• Humans
• Hyperthermia, Induced
• Male
• Middle Aged
• Neoplasm Grading
• Peritoneal Neoplasms (mortality, secondary, therapy)
• Prognosis
• Prospective Studies
• Survival Rate