Extensive surgical history prior to cytoreductive surgery and hyperthermic intraperitoneal chemotherapy is associated with poor survival outcomes in patients with peritoneal mucinous carcinomatosis of appendiceal origin

Eur J Surg Oncol. 2015 Jul;41(7):881-5. doi: 10.1016/j.ejso.2015.02.016. Epub 2015 Apr 13.

Abstract

Background: Patients with PMCA commonly undergo surgery before CRS/HIPEC. We evaluated the role of extensive surgical treatment before CRS/HIPEC in terms of overall survival (OS).

Methods: 105 patients with PMCA who underwent a CRS/HIPEC procedure were identified from a prospective database. Patients were divided into two groups based on Prior Surgery Score (PSS): PSS ≤ 1 limited surgery group (LSG), PSS >1 extensive surgery group (ESG). Survival of lymph node (LN) negative and positive patients was analyzed separately.

Results: 40 patients were in LSG and 65 in ESG. Mean time from diagnosis to CRS/HIPEC was 6 and 17 months for LSG and ESG, respectively (p = 0.004). Groups were well balanced in peritoneal cancer index, complete cytoreduction rate, and LN status. One, 3, and 5-year OS among LN negative patients was 95, 83, and 75% for the LSG (n = 22) group and 87, 55, and 32% for the ESG (n = 35), group respectively (p = 0.026). One, 3, and 5-year OS among LN positive patients was 69, 50, and 17% for the LSG (n = 18) group and 80, 21, and 14% for the ESG (n = 30), group respectively (p = 0.613). For all patients 1, 3, and 5-year OS was 84, 65, and 54% for the LSG (n = 40) group and 86, 43, and 26% for the ESG (n = 65) group, respectively (p = 0.029).

Conclusion: Extensive surgical treatment before CRS/HIPEC is associated with delay of CRS/HIPEC and poorer OS overall, especially among LN negative patients. We recommend early referral of PMCA patients to a peritoneal surface malignancy center.

Keywords: Cytoreductive surgery/HIPEC; Mucinous appendiceal neoplasms; Survival.

MeSH terms

  • Abdomen / surgery*
  • Adenocarcinoma, Mucinous / drug therapy
  • Adenocarcinoma, Mucinous / secondary
  • Adenocarcinoma, Mucinous / surgery
  • Adenocarcinoma, Mucinous / therapy*
  • Adult
  • Aged
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Appendiceal Neoplasms / drug therapy
  • Appendiceal Neoplasms / pathology*
  • Appendiceal Neoplasms / surgery
  • Chemotherapy, Cancer, Regional Perfusion* / methods
  • Cytoreduction Surgical Procedures*
  • Digestive System Surgical Procedures / adverse effects
  • Female
  • Gynecologic Surgical Procedures / adverse effects
  • Herniorrhaphy / adverse effects
  • Humans
  • Hyperthermia, Induced*
  • Lymphatic Metastasis
  • Male
  • Middle Aged
  • Peritoneal Neoplasms / drug therapy
  • Peritoneal Neoplasms / secondary
  • Peritoneal Neoplasms / surgery
  • Peritoneal Neoplasms / therapy*
  • Retrospective Studies
  • Surgical Procedures, Operative / adverse effects*
  • Treatment Outcome