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Surgical management for peritoneal carcinomatosis of appendiceal origin with a high-tumor burden

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Abstract

Purpose

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) is the active treatment for peritoneal carcinomatosis of appendiceal origin. However, surgical management is sometimes difficult in patients with a high-tumor burden.

Methods

A high-tumor burden was defined as a peritoneal cancer index (PCI) ≥ 28. Among 49 patients receiving CRS + HIPEC, 29 had a PCI ≥ 28.

Results

Complete cytoreduction (CC-0/1) was achieved in 20 of the 29 patients with a PCI ≥ 28 and in all 20 patients with a PCI < 28. Among the patients achieving CC-0/1, gastrectomy or total colectomy was performed more frequently, the hospital stay was longer and postoperative complications were more frequent in those with a PCI ≥ 28 than in those with a PCI < 28. If CC-0/1 was achieved, the overall survival was comparable between patients with a PCI ≥ 28 and a PCI < 28. However, the recurrence-free survival was significantly worse for patients with a PCI ≥ 28 than for those with a PCI < 28 (5-year survival: 73.7% vs. 5.9%). Patients with recurrence who underwent repeat CRS showed a better overall survival than those without repeat CRS. Among patients with a PCI ≥ 28, a performance status (PS) of 2/3 was a significant prognostic factor (hazard ratio = 5.132).

Conclusions

In patients with a high-tumor burden undergoing CRS + HIPEC, postoperative complications were more frequent, and the recurrence rate was higher than in those without a high-tumor burden. Repeat CRS improved the survival of patients with recurrence. The PS was a key indicator when selecting patients suitable for aggressive resection.

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Acknowledgements

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Authors and Affiliations

  1. Department of Surgery, Kishiwada City Hospital, 1001 Gakuhara-cho, Kishiwada, Osaka, 596-8501, Japan

    Toshiyuki Kitai, Kenya Yamanaka, Naoko Sugimoto & Osamu Inamoto

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  1. Toshiyuki Kitai
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  2. Kenya Yamanaka
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  3. Naoko Sugimoto
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  4. Osamu Inamoto
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Correspondence to Toshiyuki Kitai.

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Kitai, T., Yamanaka, K., Sugimoto, N. et al. Surgical management for peritoneal carcinomatosis of appendiceal origin with a high-tumor burden. Surg Today 50, 171–177 (2020). https://doi.org/10.1007/s00595-019-01856-z

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  • DOI: https://doi.org/10.1007/s00595-019-01856-z

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