Peritoneal Spread of Low-grade Appendiceal Tumours - 2 Days of Early Postoperative Intra-peritoneal Chemotherapy Are Enough

Anticancer Res. 2021 Nov;41(11):5569-5575. doi: 10.21873/anticanres.15370.


Background/aim: While controversial, cytoreductive surgery (CRS) with heated intra-peritoneal chemotherapy (HIPEC) and early postoperative intra-peritoneal chemotherapy (EPIC) remains the mainstay of treatment for low grade appendiceal neoplasm with pseudomyxoma peritonei (PMP). Our study aimed to investigate the difference in survival when administering HIPEC alone vs. HIPEC + EPIC. Additionally, we examined whether the duration of EPIC affects survival.

Patients and methods: We compared the difference in survival in 238 patients who underwent CRS + HIPEC alone vs. CRS + HIPEC/EPIC combination for low grade appendiceal cancer. We also compared short course (1-2 days) vs. long course (3-5 days) of EPIC.

Results: HIPEC/EPIC combination group (n=179) showed a significantly better 5-year survival of 95% compared to 71% in HIPEC alone (n=59). There was no statistically significant difference in 5-year survival between short course (n=22) and long course of EPIC (n=157).

Conclusion: Combined use of HIPEC and EPIC improves 5-year survival in low-grade appendiceal neoplasm. Two days of EPIC are sufficient.

Keywords: Appendiceal neoplasm; cytoreductive surgery (CRS); early postoperative intra-peritoneal chemotherapy (EPIC); heated intra-peritoneal chemotherapy (HIPEC); pseudomyxoma peritonei (PMP).

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Appendiceal Neoplasms / mortality
  • Appendiceal Neoplasms / pathology
  • Appendiceal Neoplasms / therapy*
  • Chemotherapy, Adjuvant
  • Cytoreduction Surgical Procedures* / adverse effects
  • Cytoreduction Surgical Procedures* / mortality
  • Databases, Factual
  • Female
  • Humans
  • Hyperthermic Intraperitoneal Chemotherapy* / adverse effects
  • Hyperthermic Intraperitoneal Chemotherapy* / mortality
  • Male
  • Middle Aged
  • Neoplasm Grading
  • Peritoneal Neoplasms / mortality
  • Peritoneal Neoplasms / secondary
  • Peritoneal Neoplasms / therapy*
  • Pseudomyxoma Peritonei / mortality
  • Pseudomyxoma Peritonei / secondary
  • Pseudomyxoma Peritonei / therapy*
  • Retrospective Studies
  • Time Factors
  • Treatment Outcome
  • Young Adult