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. 2012 May;19(5):1386-93.
doi: 10.1245/s10434-012-2241-6.

Aggressive management of peritoneal carcinomatosis from mucinous appendiceal neoplasms

Frances Austin  1 , Arun Mavanur, Magesh Sathaiah, Jennifer Steel, Diana Lenzner, Lekshmi Ramalingam, Matthew Holtzman, Steven Ahrendt, James Pingpank, Herbert J Zeh, David L Bartlett, Haroon A Choudry
Affiliations

Aggressive management of peritoneal carcinomatosis from mucinous appendiceal neoplasms

Frances Austin et al. Ann Surg Oncol. 2012 May.

Abstract

Background: Peritoneal carcinomatosis (PC) in the setting of mucinous appendiceal neoplasms is characterized by the intraperitoneal accumulation of mucinous ascites and mucin-secreting epithelial cells that leads to progressive compression of intra-abdominal organs, morbidity, and eventual death. We assessed postoperative and oncologic outcomes after aggressive surgical management by experienced surgeons.

Methods: We analyzed clinicopathologic, perioperative, and oncologic outcome data in 282 patients with PC from appendiceal adenocarcinomas between 2001 and 2010 from a prospective database. Kaplan–Meier survival curves and multivariate Cox-regression models were used to identify prognostic factors affecting oncologic outcomes.

Results: Adequate cytoreduction was achieved in 82% of patients (completeness of cytoreduction score (CC)-0: 49%; CC-1: 33%). Median simplified peritoneal cancer index (SPCI), operative time, and estimated blood loss were 14 (range, 0–21), 483.5 min (range, 46–1,402), and 800 ml (range, 0–14,000), respectively. Pathology assessment demonstrated high-grade tumors in 36% of patients and lymph node involvement in 23% of patients. Major postoperative morbidity occurred in 70 (25%) patients. Median overall survival was 6.72 years (95% confidence interval (CI), 4.17 years not reached), with 5 year overall survival probability of 52.7% (95% CI, 42.4, 62%). In a multivariate Cox-regression model, tumor grade, age, preoperative SPCI and chemo-naïve status at surgery were joint significant predictors of overall survival. Tumor grade, postoperative CC-score, prior chemotherapy, and preoperative SPCI were joint significant predictors of time to progression.

Conclusions: Aggressive management of PC from mucinous appendiceal neoplasms, by experienced surgeons, to achieve complete cytoreduction provides long-term survival with low major morbidity.

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Figures

FIG. 1
FIG. 1
a Kaplan–Meier overall survival curve for all patients treated with cytoreductive surgery and hyperthermic intraperitoneal chemoperfusion (n = 282). Median survival was 6.72 years (95% CI, 4.17 years, not reached); 3- and 5- year overall survival probability was 67.4 and 52.7%, respectively. b Kaplan–Meier curve for time to progression for patients treated with cytoreductive surgery and hyperthermic intraperitoneal chemoperfusion (n = 214). Median time to progression was 1.79 years (95% CI, 1.56–2.48); 3- and 5- year overall survival probability was 45.1 and 32.1% respectively
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