Peritoneal surface disease (PSD) from appendiceal cancer treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC): Overview of 481 cases.

Abstract

565 Background: Appendiceal cancer PSD treated with CRS/HIPEC has shown significant variability in the obtained survival benefit. Methods: A prospective database of 1,069 procedures was reviewed for primary, grade, nodal and performance status, resection type, morbidity, mortality, and survival. Results: 481 CRS/HIPEC procedures, 317 (77.3%) for low grade (LGA) and 93 (22.7%) for high grade (HGA) appendiceal primaries, were identified. Median follow up was 44.4 months. 30 and 90 day major morbidity were 27.8% and 9.3% while the 30 and 90 day mortality was 2.7% and 5.6% respectively. Median ICU and hospital stay was 1 and 9 days. In multivariate analysis, Clavien III/IV complications, were related to incomplete CRS (p = 0.0037), involved nodes (p < 0.0001) and comorbidities (p = 0.003). Multivariate analysis of the LGA patients indicated survival to be dependent on nodal status (p = 0.003 HR 3.6), complete cytoreduction (p < 0.0001) and preoperative chemotherapy (p = 0.04 HR 2.2). The multivariate survival of HGA was dependent on complete cytoreduction (p = 0.0003 HR 3.8) and preoperative chemotherapy (p = 0.0064 HR 2.5). In patients with complete cytoreduction, median survival for node positive LGA and HGA patients was less than their node negative counterparts. (85 months vs. not reached (82% alive at 90 months) and 30 vs. 153 months respectively p < 0.0001). Conclusions: Positive nodes are associated with decreased survival not only in HGA but also in LGA patients even after a complete cytoreduction. Nodal status is superior to grade of disease as a prognostic indicator of survival. Node negative HGA primaries after complete CRS can obtain a comparable survival benefit to LGA counterparts.