Adverse Events Postoperatively Had No Impact on Long-Term Survival of Patients Treated with Cytoreductive Surgery with Heated Intraperitoneal Chemotherapy for Appendiceal Cancer with Peritoneal Metastases

Ann Surg Oncol. 2016 Dec;23(13):4231-4237. doi: 10.1245/s10434-016-5355-4. Epub 2016 Jun 23.


Background: Appendiceal cancer most commonly metastasizes to the peritoneum. Cytoreductive surgery (CRS) with heated intraperitoneal chemotherapy (HIPEC) is the standard of care for appendiceal cancer with peritoneal metastases. Adverse events postoperatively have been associated with reduced survival. We analyzed clinical outcomes, including complications after CRS and HIPEC in patients with appendiceal cancer, in a recent cohort of patients to identify prognostic factors.

Methods: Patients undergoing CRS with HIPEC for appendix cancer with peritoneal metastases between January 2007 and December 2009 were identified. Prospectively collected data were analyzed, including preoperative, intraoperative, and postoperative variables, and multivariate Cox regression models were developed to identify factors independently predicting overall survival (OS).

Results: A total of 133 consecutive patients with a median age of 51 years were analyzed; 53.4 % were female. Pre-, intra-, and postoperative clinical variables analyzed for their impact on survival included sex, age, prior surgical score, Peritoneal Cancer Index, completeness of cytoreduction score, histology, lymph node metastases, operative time, blood transfusion, fresh frozen plasma transfusion, perioperative chemotherapy, postoperative complications, length of hospitalization, and disease recurrence. OS at 5 years was 74.4 %, and 5-year recurrence-free survival (RFS) of patients with a complete cytoreduction (CC ≤ 1) was 65.5 %. Factors independently predicting shorter survival included peritoneal mucinous adenocarcinoma (PMCA) histology (hazard ratio [HR] 15.2, 95 % confidence interval [CI] 3.38-69.0), lymph node metastasis (HR 3.82, 95 % CI 1.13-12.8), and incomplete cytoreduction [CC3; HR 13.7, 95 % CI 3.18-59.1). An incomplete cytoreduction was associated with the PMCA variant (p < 0.001). Postoperative complications grade I/II (p = 0.113) and grade III/IV (p = 0.669) had no impact on OS in multivariate analysis.

Conclusion: CRS with HIPEC can achieve long-term survival for patients with appendix cancer with peritoneal metastases. Histologic subtype, lymph node metastasis, and incomplete cytoreduction are the significant predictors of OS. Postoperative adverse events had no impact on survival.

MeSH terms

  • Adenocarcinoma, Mucinous / secondary
  • Adenocarcinoma, Mucinous / therapy*
  • Adult
  • Antineoplastic Agents / administration & dosage
  • Antineoplastic Agents / adverse effects*
  • Appendiceal Neoplasms / pathology
  • Appendiceal Neoplasms / therapy*
  • Cytoreduction Surgical Procedures / adverse effects*
  • Disease-Free Survival
  • Female
  • Humans
  • Hyperthermia, Induced / adverse effects*
  • Kaplan-Meier Estimate
  • Lymphatic Metastasis
  • Male
  • Middle Aged
  • Neoplasm, Residual
  • Peritoneal Neoplasms / secondary
  • Peritoneal Neoplasms / therapy*
  • Postoperative Complications / etiology
  • Proportional Hazards Models
  • Retrospective Studies
  • Survival Rate
  • Time Factors


  • Antineoplastic Agents