Delay of cytoreductive surgery and heated intraperitoneal chemotherapy in patients with appendiceal neoplasm.

Abstract

Cytoreductive surgery/heated intraperitoneal chemotherapy (CRS/HIPEC) has been shown to be effective for selected patients with advanced appendiceal cancer. We propose that delaying CRS/HIPEC leads to disease progression and affects outcome. A retrospective analysis of a prospective database was carried out. Patients were divided into two groups based on time from diagnosis to CRS/HIPEC (less than 6 months = early, greater than 6 months = delayed). Comparison was made of Peritoneal Cancer Index (PCI), Prior Surgery Score (PSS), complete cytoreduction (CC), and lymph node status. Overall survival (OS) was calculated using Kaplan-Meier estimates. Of 127 patients, 50 had disseminated peritoneal adenomucinosis and 77 had peritoneal mucinous carcinomatosis (PMCA). Of patients with PMCA, 41 had early CRS/HIPEC and 36 delayed. PCI was less than 20 in 46 and 17 per cent (P = 0.007) of the early and delayed groups, respectively. CC was achieved in 88 and 61 per cent (P = 0.009) of the early and delayed groups, respectively. PSS was (2 of 3) in 51 and 91 per cent (P = 0.001) of the early and delayed groups, respectively. Five-year OS was 54 per cent for the early group and 45 per cent for the delayed group (P = 0.2). Delaying CRS/HIPEC was associated with higher tumor load and lower chance for complete cytroreduction. Longer follow-up and larger numbers are needed to determine if OS difference will reach statistical significance.

• Authors: Hatem El Halabi, Ryan MacDonald, Kimberly Studeman, Jennifer Francis, Carol Nieroda, Vadim Gushchin, Armando Sardi
• Journal: The American surgeon (Am Surg) Vol. 78 Issue 7 Pg. 745-8 (Jul 2012) ISSN: 1555-9823 [Electronic] United States
• PMID: 22748531 (Publication Type: Comparative Study, Evaluation Study, Journal Article)

Topics

• Adenocarcinoma, Mucinous (mortality, secondary, therapy)
• Appendiceal Neoplasms (mortality, pathology)
• Chemotherapy, Cancer, Regional Perfusion (methods)
• Combined Modality Therapy
• Disease Progression
• Female
• Follow-Up Studies
• Humans
• Hyperthermia, Induced
• Infusions, Parenteral
• Male
• Middle Aged
• Peritoneal Neoplasms (mortality, secondary, therapy)
• Peritoneum (surgery)
• Retrospective Studies
• Survival Analysis
• Time Factors
• Treatment Outcome