Assessment of Neoadjuvant Chemotherapy on Operative Parameters and Outcome in Patients with Peritoneal Dissemination from High-Grade Appendiceal Cancer

Abstract

High-grade appendiceal adenocarcinoma is a rare malignancy with propensity for peritoneal metastases (PM). The impact of neoadjuvant chemotherapy on operative cytoreduction (CRS) and intraperitoneal chemotherapy (HIPEC) and patient survival was reviewed. A total of 45 patients with PM from high-grade appendiceal adenocarcinoma were identified from a prospective database. All patients had laparotomy with intent to undergo CRS and HIPEC. Operative parameters, complications, and survival outcomes were analyzed. Of the 45 patients (male: 27, female: 18; median age: 55years), 26 received neoadjuvant chemotherapy±bevacizumab. Of the 26, 15 (58%) had a response based on improvement in imaging, biomarkers, or both and 9 (34%) had stable disease. The median peritoneal cancer index (PCI) was 27. Also, 30 (67%) had a completeness of cytoreduction score (CCR) of ≤1 and 37 (82%) received HIPEC. There were no differences in PCI, CCR score, operative blood loss, or major organ resection between those who received or did not receive neoadjuvant chemotherapy. Operative time was significantly shorter in those who did not receive neoadjuvant chemotherapy. Major complications and length of hospital stay were similar between the groups. The median actuarial overall survival calculated from the date of initial therapeutic intervention was not different in those treated with or without neoadjuvant therapy. Neoadjuvant chemotherapy has marked clinical activity in patients with PM from high-grade appendiceal adenocarcinoma and does not adversely affect operative outcomes. These data support conducting a prospective clinical trial to define the role of neoadjuvant chemotherapy in this clinical setting.