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. 2022 Jun;29(6):3422-3431.
doi: 10.1245/s10434-022-11440-4. Epub 2022 Mar 7.

Timing of Repeat Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy for Recurrent Low-Grade Appendiceal Mucinous Neoplasms

Cristian D Valenzuela  1 , Christopher W Mangieri  1 , Mary Garland-Kledzik  1 , Rohin Gawdi  1 , Gregory Russell  2 , Kathleen C Perry  1 , Konstantinos I Votanopoulos  1 , Edward A Levine  1 , Perry Shen  3
Affiliations

Timing of Repeat Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy for Recurrent Low-Grade Appendiceal Mucinous Neoplasms

Cristian D Valenzuela et al. Ann Surg Oncol. 2022 Jun.

Abstract

Background: Low-grade appendiceal mucinous neoplasm (LAMN) with peritoneal involvement is a common indication for cytoreductive surgery with heated intraperitoneal chemotherapy (CRS/HIPEC). With peritoneal recurrence, patients are increasingly being offered repeat CRS/HIPECs, however optimal timing for a second CRS/HIPEC remains unknown.

Methods: A prospectively maintained 30-year database at our high-volume HIPEC center was analyzed retrospectively for patients with LAMNs and peritoneal recurrence receiving one or two CRS/HIPECs. Kaplan-Meier survival analysis, linear regression modeling, and Cox proportional hazards regression analyses were performed.

Results: Overall, 143 patients with LAMNs who underwent CRS/HIPECs had confirmed postoperative peritoneal recurrence. Of these patients, 85 underwent one CRS/HIPEC and 58 underwent two CRS/HIPECs. The groups had significant differences in age, with younger patients more likely to undergo a second CRS/HIPEC (48.5 vs. 58.0 years; p < 0.001). The median overall survival (OS) for the group undergoing two CRS/HIPECs was approximately four times longer compared with the group undergoing one CRS/HIPEC (227.1 vs. 54.5 months; p < 0.0001). The time from recurrence to the second CRS/HIPEC was not significantly associated with OS from the time of the first operation. Instead, a shorter time between the first CRS/HIPEC and recurrence was significantly associated with shorter OS from the time of the first operation (p = 0.037).

Conclusion: In peritoneal LAMNs with recurrence, receiving two CRS/HIPECs was associated with better OS compared with receiving one CRS/HIPEC. Longer time to recurrence was a good prognostic factor. Delay between recurrence and second CRS/HIPEC had no apparent impact on OS from the first CRS/HIPEC; thus, immediate or delayed reoperative intervention are both reasonable approaches.

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Conflict of interest statement

DISCLOSURES Cristian D. Valenzuela, Christopher W. Mangieri, Mary Garland-Kledzik, Rohin Gawdi, Gregory Russell, Kathleen C. Perry, Konstantinos I. Votanopoulos, Edward A. Levine, and Perry Shen declare no conflicts of interest.

Figures

FIG. 1
FIG. 1
Overall survival for patients with LAMN tumors receiving one versus two CRS/HIPECs. LAMN low-grade appendiceal mucinous neoplasm, CRS/HIPEC cytoreductive surgery/hyperthermic intraperitoneal chemotherapy
FIG. 2
FIG. 2
Survival of patients with LAMN tumors and the delayed intervention approach. LAMN low-grade appendiceal mucinous neoplasm, CRS/HIPEC cytoreductive surgery/hyperthermic intraperitoneal chemotherapy, mo. months
FIG. 2
FIG. 2
Survival of patients with LAMN tumors and the delayed intervention approach. LAMN low-grade appendiceal mucinous neoplasm, CRS/HIPEC cytoreductive surgery/hyperthermic intraperitoneal chemotherapy, mo. months
FIG. 3
FIG. 3
R-status and PCI scores after first or second CRS/HIPEC. R-status resection status, PCI Peritoneal Cancer Index, CRS/HIPEC cytoreductive surgery/hyperthermic intraperitoneal chemotherapy
See this image and copyright information in PMC

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