Outcomes of neoadjuvant chemotherapy before CRS-HIPEC for patients with appendiceal cancer

J Surg Oncol. 2020 Sep;122(3):388-398. doi: 10.1002/jso.25967. Epub 2020 May 7.


Background: Cytoreductive surgery (CRS) with or without hyperthermic intraperitoneal chemotherapy (HIPEC) is indicated for patients with peritoneal dissemination of appendiceal cancer. The role of neoadjuvant chemotherapy (NAC) before CRS-HIPEC remains controversial.

Methods: A retrospective review of adult patients who underwent CRS ± HIPEC for metastatic appendiceal cancer between 2000-2017 was performed. Patients who received NAC followed by surgery were compared with those who underwent surgery first (SF) with and without 1:1 propensity score matching (PSM).

Results: Among 803 patients with appendiceal cancer who underwent CRS ± HIPEC, 225 (28%) received NAC, and 578 (72%) underwent SF. After PSM (n = 186), median overall survival (OS) did not differ (NAC: 40 vs SF: 56 months; P = .210) but recurrence-free survival (RFS) was worse among patients who received NAC (14 vs 22 months; P = .007). NAC was independently associated with worse OS (hazards ratio [HR], 1.81; 95% confidence interval [CI], 1.03-3.18) and RFS (HR, 1.93; 95% CI, 1.25-2.99).

Conclusion: In this multi-institutional retrospective analysis of patients with peritoneal dissemination from appendiceal cancer, the use of NAC before CRS-HIPEC was associated with worse OS and RFS even after PSM and multivariable regression. Immediate surgery should be considered for patients with disease amenable to complete cytoreduction.

Keywords: appendiceal cancer; cytoreductive surgery; hyperthermic intraperitoneal chemotherapy.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Appendiceal Neoplasms / drug therapy*
  • Appendiceal Neoplasms / mortality
  • Appendiceal Neoplasms / pathology
  • Appendiceal Neoplasms / surgery*
  • Chemotherapy, Adjuvant
  • Cytoreduction Surgical Procedures / methods
  • Female
  • Humans
  • Hyperthermia, Induced / methods*
  • Male
  • Middle Aged
  • Neoadjuvant Therapy
  • Neoplasm Invasiveness
  • Peritoneal Neoplasms / drug therapy
  • Peritoneal Neoplasms / mortality
  • Peritoneal Neoplasms / secondary
  • Peritoneal Neoplasms / surgery
  • Propensity Score
  • Retrospective Studies
  • Treatment Outcome
  • United States / epidemiology