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Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy: An Emerging Treatment Option for Advanced Goblet Cell Tumors of the Appendix

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The debate remains whether appendiceal goblet cell cancers behave as classical carcinoid or adenocarcinoma. Treatment options are unclear and reports of outcomes are scarce. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS+HIPEC) is considered optimal treatment for peritoneal involvement of other epithelial appendiceal tumors.

Methods

Prospective cohorts of patients treated for advanced appendiceal tumors from three peritoneal malignancy centres were collected (1994–2011). All patients underwent complete CRS+HIPEC, when possible, or tumor debulking. Demographic and outcome data for patients with goblet cell cancers were compared to patients with low- or high-grade epithelial appendiceal tumors treated during the same time period.

Results

Details on 45 goblet cell cancer patients were compared to 708 patients with epithelial appendix lesions. In the goblet cell group, 57.8 % were female, median age was 53 years, median peritoneal cancer index (PCI) was 24, and CRS+HIPEC was achieved in 71.1 %. These details were similar in patients with low- or high-grade epithelial tumors. Lymph nodes were involved in 52 % of goblet cell patients, similar to rates in high-grade cancers, but significantly higher than in low-grade lesions (6.4 %; p < 0.001). At 3 years, overall survival (OS) was 63.4 % for goblet cell patients, intermediate between that for high-grade (40.4–52.2 %) and low-grade (80.6 %) tumors. On multivariate analysis, tumor histology, PCI, and achievement of CRS+HIPEC were independently associated with OS.

Conclusions

This data supports the concept that appendiceal goblet cell cancers behave more as high-grade adenocarcinomas than as low-grade lesions. These patients have reasonable long-term survival when treated using CRS+HIPEC, and this strategy should be considered.

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Acknowledgment

No conflicts of interest and no research grants were received for this study.

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Authors and Affiliations

  1. Division of Surgical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada

    Yarrow J. McConnell M.D, Lloyd A. Mack M.D & Walley J. Temple M.D

  2. Department of Pathology and Laboratory Medicine, University of Calgary and Calgary Laboratory Services, Calgary, AB, Canada

    Xianyong Gui M.D

  3. Department of Cellular Pathology, University Hospital Southampton, Southampton, UK

    Norman J. Carr M.B

  4. Department of Surgery, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montreal, QC, Canada

    Lucas Sideris M.D & Pierre Dubé M.D

  5. Pseudomyxoma Peritonei Centre, Basingstoke and North Hampshire Hospital Foundation Trust, Hampshire, UK

    Kandiah Chandrakumaran Ph.D, Brendan J. Moran M.B & Tom D. Cecil D.M

Authors
  1. Yarrow J. McConnell M.D
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  2. Lloyd A. Mack M.D
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  3. Xianyong Gui M.D
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  4. Norman J. Carr M.B
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  5. Lucas Sideris M.D
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  6. Walley J. Temple M.D
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  7. Pierre Dubé M.D
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  8. Kandiah Chandrakumaran Ph.D
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  9. Brendan J. Moran M.B
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  10. Tom D. Cecil D.M
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Correspondence to Yarrow J. McConnell M.D.

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McConnell, Y.J., Mack, L.A., Gui, X. et al. Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy: An Emerging Treatment Option for Advanced Goblet Cell Tumors of the Appendix. Ann Surg Oncol 21, 1975–1982 (2014). https://doi.org/10.1245/s10434-013-3469-5

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  • DOI: https://doi.org/10.1245/s10434-013-3469-5

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