Abstract
BackgroundAppendiceal peritoneal carcinomatosis (PC) is rare and its long-term prognosis is poor. The aim of this study was to evaluate the results of an aggressive treatment approach used in our institution for the last eight years.MethodsData from all patients with PC arising from the appendix were prospectively collected and analyzed. Treatment consisted of complete surgical cytoreduction (CRS), followed by hyperthermic intraperitoneal chemotherapy (HIPEC) with oxaliplatin (460 mg/m2) at 43°C over 30 minutes. Ronnett’s histologic classification was used for tumor grading.ResultsBetween February 2003 and April 2011, 78 patients underwent laparotomy with curative intent. The mean follow-up period was 33.7 months. A total of 58 patients received HIPEC, but 11 patients could not have CRS and received no HIPEC. Nine patients with a negative second-look surgery also received no HIPEC. The five-year overall survival for the entire cohort was 66.2%; 100% for the negative second-look patients, 77% for the HIPEC patients and 9% for the unresectable patients (P <0.0001). A total of 15 patients (25.9%) had isolated peritoneal recurrence, no patient had visceral recurrence only, and five patients (8.6%) had both. In regards to the five-year disease-free survival for the HIPEC patients, histologic grade (disseminated peritoneal adenomucinosis 100%, peritoneal mucinous carcinomatosis with intermediate features 40%, peritoneal mucinous carcinomatosis 20%; p =0.0016) and completeness of cytoreduction (CCR-0 56%, CCR-1 24%; P =0.0172) were prognostic factors. There was one postoperative mortality. The major complication rate for patients treated with HIPEC was 40%, including intra-abdominal abcess (17%), hemorrhage (12%) and anastomotic leak (10%). One patient in the HIPEC group experienced temporary grade II neuropathy and grade III thrombocytopenia.ConclusionsThis therapeutic approach seems both feasible and safe in selected patients. Recurrence is, however, frequent and represents a challenge.
Highlights
Appendiceal peritoneal carcinomatosis (PC) is rare and its long-term prognosis is poor
A more aggressive approach consisting of complete surgical cytoreduction (CRS) and intra-peritoneal chemotherapy has been introduced by Gonzalez-Moreno and Sugarbaker in 1983, with five- and ten-year overall survival (OS) rates of 71.9% and 54.5%, respectively [5]
Patients were offered treatment consisting of maximal surgical cytoreduction and hyperthermic intraperitoneal chemotherapy (HIPEC) with oxaliplatin if they fulfilled the following criteria: diagnosis proven by histological examination, no evidence of visceral metastasis on computed tomographic (CT) imaging of the chest and abdomen, a technically resectable disease, and a general health status good enough to tolerate the proposed surgery
Summary
Appendiceal peritoneal carcinomatosis (PC) is rare and its long-term prognosis is poor. Neoplasms of the appendix are rare, with their ageadjusted incidence rate being 0.12 to 2 cases per 1,000,000 people per year [1]. They are found in about 1% of appendectomy specimens [2]. Epithelial tumors, which represent the majority of the appendiceal cancers [1], often present with peritoneal dissemination For those cases, the traditional approach has consisted in repetitive debulking surgery and the long-term prognosis (five and ten-year overall survival (OS)) of these patients has been demonstrated in two studies as being 53% and 32% [3], and 65% and 21% [4], respectively. The addition of hyperthermia to chemotherapeutic agents has been shown to enhance their cytotoxicity [16] and their penetration into tumors [16,17,18]
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