Pleuropulmonary Recurrence Following Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemoperfusion for Appendiceal Pseudomyxoma Peritonei

Ann Surg Oncol. 2019 May;26(5):1429-1436. doi: 10.1245/s10434-018-07091-z. Epub 2019 Jan 8.


Background: The aim of this study was to identify factors associated with pleuropulmonary disease recurrence following cytoreductive surgery with hyperthermic intraperitoneal chemoperfusion (CRS/HIPEC) for appendiceal pseudomyxoma peritonei (PMP) and to evaluate the oncologic impact of pleuropulmonary disease recurrence compared with isolated peritoneal recurrence.

Methods: From a prospective database, we identified patients who developed pleuropulmonary recurrence, isolated peritoneal recurrence, or no recurrence following CRS/HIPEC for appendiceal PMP. Clinicopathologic, perioperative, and oncologic data associated with the index CRS/HIPEC procedure were reviewed. The Kaplan-Meier method was used to estimate survival. Multivariate analyses identified associations with recurrence and survival.

Results: Of 382 patients undergoing CRS/HIPEC, 61 (16%) developed pleuropulmonary recurrence. Patients who developed a pleuropulmonary recurrence were more likely to have high-grade (American Joint Committee on Cancer [AJCC] grade 2/3) tumors (74% vs. 56%, p = 0.02) and increased operative blood loss (1651 vs. 1201 ml, p = 0.05) and were more likely to have undergone diaphragm stripping/resection (79% vs. 48%, p < 0.01) compared with patients with an abdominal recurrence. In a multivariate analysis, pleuropulmonary recurrence after CRS/HIPEC was associated with diaphragm stripping/resection, incomplete cytoreduction, and higher AJCC tumor grade. There was a trend towards reduced survival in patients with pleuropulmonary recurrence compared with patients with isolated peritoneal recurrence (median overall survival 45 vs. 53 months, p = 0.87).

Conclusion: Pleuropulmonary recurrence of appendiceal PMP following CRS/HIPEC is common and may negatively impact survival. Formal protocols for surveillance and therapeutic intervention need to be studied and implemented to improve oncologic outcomes.

MeSH terms

  • Antineoplastic Combined Chemotherapy Protocols / adverse effects
  • Appendiceal Neoplasms / pathology
  • Appendiceal Neoplasms / therapy*
  • Chemotherapy, Cancer, Regional Perfusion / adverse effects
  • Combined Modality Therapy
  • Cytoreduction Surgical Procedures / adverse effects*
  • Female
  • Follow-Up Studies
  • Humans
  • Hyperthermia, Induced / adverse effects*
  • Lung Neoplasms / epidemiology
  • Lung Neoplasms / etiology
  • Lung Neoplasms / mortality*
  • Lung Neoplasms / pathology
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local / epidemiology
  • Neoplasm Recurrence, Local / etiology
  • Neoplasm Recurrence, Local / mortality*
  • Neoplasm Recurrence, Local / pathology
  • Pleural Neoplasms / epidemiology
  • Pleural Neoplasms / etiology
  • Pleural Neoplasms / mortality*
  • Pleural Neoplasms / pathology
  • Prognosis
  • Prospective Studies
  • Pseudomyxoma Peritonei / pathology
  • Pseudomyxoma Peritonei / therapy*
  • Retrospective Studies
  • Survival Rate