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Surgical Cytoreduction and Survival in Appendiceal Cancer Peritoneal Carcinomatosis: An Evaluation of 46 Consecutive Patients

  • Colorectal Cancer
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Abstract

Background

Surgical cytoreduction and intraperitoneal chemotherapy is increasingly accepted as an effective treatment modality for mucinous appendiceal neoplasm. For the majority of patients with low-grade histology, outcomes have been encouraging. The survival of patients with neoplasms of malignant character is protracted and this study was designed to evaluate the effectiveness of this surgical strategy on outcomes.

Methods

Forty-six consecutive patients with mucinous and nonmucinous appendiceal cancer with peritoneal dissemination were studied. Clinicopathological and treatment related factors were obtained from a prospective database. The study’s end points of disease-free survival (DFS) and overall survival (OS) were analyzed using the Kaplan-Meier method.

Results

The median DFS and OS after cytoreduction were 20.5 and 56.4 months respectively. Five-year overall survival rate was 45%. Five independent factors associated with DFS and OS were identified through a multivariate analysis: age (DFS p = 0.001, OS p = 0.002), completeness of cytoreduction (DFS p = 0.001, OS p = 0.003), previous chemotherapy treatment (DFS p = 0.021), CA 199 levels (DFS p = 0.013), and tumor grade (OS p = 0.005).

Conclusions

Cytoreductive surgery and intraperitoneal chemotherapy may achieve long-term survival in appendiceal malignancies with peritoneal dissemination for which the predictors of outcomes identified through this study may tailor the disease management to commit patients early toward this successful surgical strategy.

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References

  1. Carr NJ, Sobin LH. Neuroendocrine tumors of the appendix. Semin Diagn Pathol. 2004;21(2):108–19.

    Article  PubMed  Google Scholar 

  2. Sugarbaker PH. Epithelial appendiceal neoplasms. Cancer J. 2009;15(2):225–35.

    Article  PubMed  Google Scholar 

  3. Chu DZ, Lang NP, Thompson C, Osteen PK, Westbrook KC. Peritoneal carcinomatosis in nongynecologic malignancy. A prospective study of prognostic factors. Cancer. 1989;63(2):364–7.

    Article  PubMed  CAS  Google Scholar 

  4. Sadeghi B, Arvieux C, Glehen O, Beaujard AC, Rivoire M, Baulieux J, et al. Peritoneal carcinomatosis from non-gynecologic malignancies: results of the EVOCAPE 1 multicentric prospective study. Cancer. 2000;88(2):358–63.

    Article  PubMed  CAS  Google Scholar 

  5. Bradley RF, Stewart JH, Russell GB, Levine EA, Geisinger KR. Pseudomyxoma peritonei of appendiceal origin: a clinicopathologic analysis of 101 patients uniformly treated at a single institution, with literature review [see comment]. Am J Surg Pathol. 2006;30(5):551–9.

    Article  PubMed  Google Scholar 

  6. Elias D, Glehen O, Pocard M, Quenet F, Goere D, Arvieux C, et al. A comparative study of complete cytoreductive surgery plus intraperitoneal chemotherapy to treat peritoneal dissemination from colon, rectum, small bowel, and nonpseudomyxoma appendix. Ann Surg. 2010;251:896–901.

    Article  PubMed  Google Scholar 

  7. Chua TC, Yan TD, Smigielski ME, Zhu KJ, Ng KM, Zhao J, et al. Long-term survival in patients with pseudomyxoma peritonei treated with cytoreductive surgery and perioperative intraperitoneal chemotherapy: 10 years of experience from a single institution. Ann Surg Oncol. 2009;16(7):1903–11.

    Article  PubMed  Google Scholar 

  8. Jacquet P, Sugarbaker PH. Current methodologies for clinical assessment of patients with peritoneal carcinomatosis. J Exp Clin Cancer Res. 1996;15:49–58.

    Google Scholar 

  9. Sugarbaker PH. Peritonectomy procedures. Ann Surg. 1995;221(1):29–42.

    Article  PubMed  CAS  Google Scholar 

  10. Ronnett BM, Zahn CM, Kurman RJ, Kass ME, Sugarbaker PH, Shmookler BM. Disseminated peritoneal adenomucinosis and peritoneal mucinous carcinomatosis. A clinicopathologic analysis of 109 cases with emphasis on distinguishing pathologic features, site of origin, prognosis, and relationship to “pseudomyxoma peritonei.” Am J Surg Pathol. 1995;19(12):1390–408.

    Article  PubMed  CAS  Google Scholar 

  11. Chua TC, Yan TD, Zhao J, Morris DL. Peritoneal carcinomatosis and liver metastases from colorectal cancer treated with cytoreductive surgery perioperative intraperitoneal chemotherapy and liver resection. Eur J Surg Oncol. 2009;35(12):1299–305.

    PubMed  CAS  Google Scholar 

  12. Chua TC, Liauw W, Zhao J, Morris DL. Upfront compared to delayed cytoreductive surgery and perioperative intraperitoneal chemotherapy for pseudomyxoma peritonei is associated with considerably lower perioperative morbidity and recurrence rate. Ann Surg. 2011;253(4):769–73.

    Google Scholar 

  13. Omohwo C, Nieroda CA, Studeman KD. Complete cytoreduction offers long-term survival in patients with peritoneal carcinomatosis from appendiceal tumors of unfavorable histology. J Am Coll Surg. 2009;209(3):308–12.

    Article  PubMed  Google Scholar 

  14. Yao JC, Tseng JF, Worah S, Hess KR, Mansfield PF, Crane CH, et al. Clinicopathologic behavior of gastric adenocarcinoma in Hispanic patients: analysis of a single institution’s experience over 15 years. J Clin Oncol. 2005;23(13):3094–103.

    Article  PubMed  Google Scholar 

  15. Chua TC, Koh JL, Yan TD, Liauw W, Morris DL. Cytoreductive surgery and perioperative intraperitoneal chemotherapy for peritoneal carcinomatosis from small bowel adenocarcinoma. J Surg Oncol. 2009;100(2):139–43.

    Article  PubMed  Google Scholar 

  16. Kang H, O’Connell JB, Maggard MA, Sack J, Ko CY. A 10-year outcomes evaluation of mucinous and signet-ring cell carcinoma of the colon and rectum. Dis Colon Rectum. 2005;48(6):1161–8.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Hepatobiliary and Surgical Oncology Unit, UNSW Department of Surgery, St George Hospital, Sydney, NSW, Australia

    Terence C. Chua BScMed (Hons), MBBS, Ihssan Al-Alem MBBS, Akshat Saxena BMedSc & David L. Morris MD, PhD

  2. Department of Medical Oncology, Cancer Care Centre, St George Hospital, Sydney, NSW, Australia

    Winston Liauw MBBS, FRACP

Authors
  1. Terence C. Chua BScMed (Hons), MBBS
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  2. Ihssan Al-Alem MBBS
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  3. Akshat Saxena BMedSc
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  4. Winston Liauw MBBS, FRACP
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  5. David L. Morris MD, PhD
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Corresponding author

Correspondence to David L. Morris MD, PhD.

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Chua, T.C., Al-Alem, I., Saxena, A. et al. Surgical Cytoreduction and Survival in Appendiceal Cancer Peritoneal Carcinomatosis: An Evaluation of 46 Consecutive Patients. Ann Surg Oncol 18, 1540–1546 (2011). https://doi.org/10.1245/s10434-011-1714-3

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  • DOI: https://doi.org/10.1245/s10434-011-1714-3

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