Repeated Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy in Peritoneal Carcinomatosis From Appendiceal Cancer: Analysis of Survival Outcomes

Eur J Surg Oncol. 2013 Nov;39(11):1207-13. doi: 10.1016/j.ejso.2013.08.017. Epub 2013 Sep 2.

Abstract

Background: Cytoreductive surgery (CRS)/hyperthermic intraperitoneal chemotherapy (HIPEC) is the procedure of choice in patients with peritoneal dissemination from appendiceal cancer. Although recurrence rates are 26%-44% after first CRS/HIPEC, the role of repeated CRS/HIPEC has not been well defined. We hypothesize that patients undergoing multiple CRS/HIPEC's have meaningful long term survival.

Methods: A retrospective study of a prospective database of 294 patients with peritoneal carcinomatosis (PC) was conducted, of these 162 had PC of appendiceal origin. Twenty-six of these patients underwent 56 CRS/HIPEC. Survival and outcomes was analyzed.

Results: The percentage of patients with pre-surgical PCI scores ≥ 20 for the first, second, and third CRS/HIPEC was 65, 65, and 25%, respectively. Complete cytoreduction (CC 0-1) at first, second, and, third surgeries was 96, 65 and 75%, respectively. The mean operating time was 10.1 h. There was no 30-day peri-operative mortality. Following the first, second, and third CRS/HIPEC 27, 42, and 50% experienced grade III complications, respectively. Mean follow up was 51, 28, and 16 months from the first, second, and third CRS/HIPEC, respectively. Overall survival rate for the first CRS/HIPEC was 100, 83, 54, and 46% at years 1, 3, 5 and 10, respectively; from the second CRS/HIPEC 91, 53, and 34% at 1, 3, and 5 years, respectively; and from the third CRS/HIPEC was 75% at one year.

Conclusion: Repeat CRS/HIPEC can lead to meaningful long term survival rates in patients with appendiceal peritoneal carcinomatosis with morbidity and mortality similar to those of the initial CRS/HIPEC.

Keywords: Appendix cancer; Cytoreductive surgery; HIPEC; Peritoneal carcinomatosis; Repeated HIPEC; Survival.

MeSH terms

  • Adult
  • Aged
  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Appendiceal Neoplasms / pathology*
  • Carboplatin / administration & dosage
  • Carcinoma / drug therapy
  • Carcinoma / mortality*
  • Carcinoma / secondary
  • Carcinoma / surgery
  • Carcinoma / therapy*
  • Chemotherapy, Adjuvant
  • Databases, Factual
  • Digestive System Surgical Procedures* / adverse effects
  • Female
  • Humans
  • Hyperthermia, Induced*
  • Infusions, Parenteral
  • Kaplan-Meier Estimate
  • Length of Stay
  • Male
  • Melphalan / administration & dosage
  • Middle Aged
  • Mitomycin / administration & dosage
  • Peritoneal Neoplasms / drug therapy
  • Peritoneal Neoplasms / mortality*
  • Peritoneal Neoplasms / secondary
  • Peritoneal Neoplasms / surgery
  • Peritoneal Neoplasms / therapy*
  • Reoperation
  • Retrospective Studies
  • Treatment Outcome

Substances

  • Mitomycin
  • Carboplatin
  • Melphalan