Annals of Surgical Oncology

, Volume 13, Issue 5, pp 635–644 | Cite as

Prospective Morbidity and Mortality Assessment of Cytoreductive Surgery Plus Perioperative Intraperitoneal Chemotherapy To Treat Peritoneal Dissemination of Appendiceal Mucinous Malignancy

  • Paul H. Sugarbaker
  • Robert Alderman
  • Gary Edwards
  • Christina Ellen Marquardt
  • Vadim Gushchin
  • Jesus Esquivel
  • David Chang
Article

Abstract

Background

Appendiceal mucinous neoplasms present, in most patients, with peritoneal dissemination at the time of initial diagnosis. Patients may have a borderline tumor showing disseminated peritoneal adenomucinosis or an aggressive malignancy identified as peritoneal mucinous adenocarcinoma. Patients with these diagnoses were treated by cytoreductive surgery and perioperative intraperitoneal chemotherapy.

Methods

A database was established in 1998 that prospectively evaluated the morbidity and mortality of this group of patients. By using common toxicity grading criteria, 8 categories were scored on a grade of I to V. Grade IV indicated that the adverse event required urgent and definitive intervention: often a return to the operating room or to the surgical intensive care unit. Grade V indicated that the adverse events resulted in the patient’s death. Adverse events were tabulated for each cytoreduction performed in these appendiceal malignancy patients.

Results

There were 356 procedures in patients taken to the operating room who received cytoreductive surgery with peritonectomy procedures plus heated intraoperative intraperitoneal chemotherapy. Only patients who had this combined treatment at our institution were included in the analysis. The total 30-day or in-hospital mortality was 2.0%. Nineteen percent of procedures were accompanied by at least one grade IV adverse event, and 11.1% of patients returned to the operating room. The most common category of grade IV complications was hematological (28%), followed by gastrointestinal (26%).

Conclusions

The mortality of 2.0% and the overall grade IV morbidity of 19% in these patients may be acceptable in light of modern standards for the management of gastrointestinal cancer.

Keywords

Cytoreductive surgery Hyperthermia Peritonectomy Intraperitoneal chemotherapy Mitomycin C 5-Fluorouracil 

References

  1. 1.
    Gough DB, Donohue JH, Schutt AJ, et al. Pseudomyxoma peritonei. Long-term patient survival with an aggressive regional approach. Ann Surg Oncol 1994;219:112–9Google Scholar
  2. 2.
    Misdraji J, Yantiss RK, Graeme-Cook FM, Balis UJ, Young RH. Appendiceal mucinous neoplasms. A clinicopathological analysis of 107 cases. Am J Surg Pathol 2003;27:1089–103CrossRefPubMedGoogle Scholar
  3. 3.
    Miner TJ, Shia J, Jaques DP, Klimstra DS, Brennan MF, Coit DG. Long-term survival following treatment of pseudomyxoma peritonei. An analysis of surgical therapy. Ann Surg 2005;241:300–8CrossRefPubMedGoogle Scholar
  4. 4.
    Sugarbaker PH. Results of treatment of 385 patients with peritoneal surface spread of appendiceal malignancy. Ann Surg Oncol 1999;6:727–31.CrossRefPubMedGoogle Scholar
  5. 5.
    Shen P, Levine EA, Hall J, et al. Factors predicting survival after intraperitoneal hyperthermic chemotherapy with mitomycin C after cytoreductive surgery for patients with peritoneal carcinomatosis. Arch Surg 2003;138:26–33PubMedGoogle Scholar
  6. 6.
    Van Ruth S, Acherman YIZ, van de Vijver MJ, Hart AAM, Verwaal VJ, Zoetmulder FAN. Pseudomyxoma peritonei: a review of 62 cases. Eur J Surg Oncol 2003;29:682–8PubMedGoogle Scholar
  7. 7.
    Deraco M, Baratti D, Inglese MG, et al. Peritonectomy and intraperitoneal hyperthermic perfusion (IPHP): a strategy that has confirmed its efficacy in patients with pseudomyxoma peritonei. Ann Surg Oncol 2004;11:393–8CrossRefPubMedGoogle Scholar
  8. 8.
    Güner Z, Schmidt U, Dahlke MH, Schlitt HJ, Klempnauer J, Piso P. Cytoreductive surgery and intraperitoneal chemotherapy for pseudomyxoma peritonei. Int J Colorectal Dis 2005; 20:155–60CrossRefPubMedGoogle Scholar
  9. 9.
    Loungnarath R, Causeret S, Bossard N, et al. Cytoreductive surgery with intraperitoneal chemohyperthermia for the treatment of pseudomyxoma peritonei: a prospective study. Dis Colon Rectum 2005; 48:1372–9CrossRefPubMedGoogle Scholar
  10. 10.
    Sugarbaker PH. Peritonectomy procedures. Ann Surg 1995;221:29–42PubMedGoogle Scholar
  11. 11.
    De Lima Vazquez V, Sugarbaker PH. Cholecystectomy, lesser omentectomy and stripping of the omental bursa, a peritonectomy procedure. J Surg Onco 2003;84:45–9Google Scholar
  12. 12.
    De Lima Vazquez V, Sugarbaker PH. Total anterior parietal peritonectomy. J Surg Oncol 2003;83:261–3Google Scholar
  13. 13.
    Sugarbaker PH. Cytoreduction including total gastrectomy for pseudomyxoma peritonei. Br J Surg 2002;89:202–12Google Scholar
  14. 14.
    Sugarbaker PH. Management of Peritoneal Surface Malignancy Using Intraperitoneal Chemotherapy and Cytoreductive Surgery. A Manual for Physicians and Nurses. 3rd ed. Grand Rapids, MI: Ludann Co, 1998Google Scholar
  15. 15.
    Sugarbaker PH, Averbach AM, Jacquet P, Stephens AD, Stuart OA. A simplified approach to hyperthermic intraoperative intraperitoneal chemotherapy (HIIC) using a self retaining retractor. In: Sugarbaker PH, ed. Peritoneal Carcinomatosis: Principles of Management. Boston: Kluwer, 1996: 415–21Google Scholar
  16. 16.
    Yan H, Pestieau SR, Shmookler BM, Sugarbaker PH. Histopathologic analysis in 46 patients with pseudomyxoma peritonei syndrome: failure vs. success with a second-look operation. Mod Pathol 2001;14:164–71CrossRefPubMedGoogle Scholar
  17. 17.
    Ronnett BM, Shmookler BM, Sugarbaker PH, Kurman RJ. Pseudomyxoma peritonei: new concepts in diagnosis, origin, nomenclature, relationship to mucinous borderline (low malignant potential) tumors of the ovary. In: Fechner RE, Rosen PP, eds. Anatomic Pathology. Chicago: ASCP Press, 1997:197–226Google Scholar
  18. 18.
    Sugarbaker PH. Successful management of microscopic residual disease in large bowel cancer. Cancer Chemother Pharmacol 1999;43(Suppl):S15–25PubMedGoogle Scholar
  19. 19.
    Schnake KJ, Sugarbaker PH, Yoo D. Neutropenia following perioperative intraperitoneal chemotherapy. Tumori 1999;85:41–6PubMedGoogle Scholar
  20. 20.
    Sugarbaker PH, Kern K, Lack E. Malignant pseudomyxoma of colonic origin. Natural history and presentation of a curative approach to treatment. Dis Colon Rectum 1987;30:772–9PubMedGoogle Scholar
  21. 21.
    Sugarbaker PH, Jablonski KA. Prognostic features of 51 colorectal and 130 appendiceal cancer patients with peritoneal carcinomatosis treated by cytoreductive surgery and intraperitoneal chemotherapy. Ann Surg 1995;221:124–32PubMedGoogle Scholar
  22. 22.
    Murio JE, Sugarbaker PH. Gastrointestinal fistula following cytoreductive procedures for peritoneal carcinomatosis: incidence and outcome. J Exp Clin Cancer Res 1993;3:153–8Google Scholar
  23. 23.
    Fernandez-Trigo V, Sugarbaker PH. Diagnosis and management of postoperative gastrointestinal fistulas: a kinetic analysis. J Exp Clin Cancer Res 1994;13:233–41Google Scholar
  24. 24.
    Esquivel J, Vidal-Jove J, Steves MA, Sugarbaker PH. Morbidity and mortality of cytoreductive surgery and intraperitoneal chemotherapy. Surgery 1993;113:631–6PubMedGoogle Scholar
  25. 25.
    Jacquet P, Stephens AD, Averbach AM, et al. Analysis of morbidity and mortality in 60 patients with peritoneal carcinomatosis treated by cytoreductive surgery and heated intraoperative intraperitoneal chemotherapy. Cancer 1996;77:2622–9CrossRefPubMedGoogle Scholar
  26. 26.
    Stephens AD, Alderman R, Chang D, et al. Morbidity and mortality of 200 treatments with cytoreductive surgery and hyperthermic intraoperative intraperitoneal chemotherapy using the Coliseum technique. Ann Surg Oncol1999;6:790–6CrossRefPubMedGoogle Scholar
  27. 27.
    Sugarbaker PH, Welch L, Mohamed F, Glehen O. A review of peritoneal mesothelioma at the Washington Cancer Institute. Surg Oncol Clin North Am 2003;12:605–21Google Scholar
  28. 28.
    Elias D, Blot F, Et Otmany A, et al. Curative treatment of peritoneal carcinomatosis arising from colorectal cancer by complete resection and intraperitoneal chemotherapy. Cancer 2001;92:71–6CrossRefPubMedGoogle Scholar
  29. 29.
    Butterworth SA, Panton ONM, Klaassen DJ, Shah AM, McGregor GI. Morbidity and mortality associated with intraperitoneal chemotherapy for pseudomyxoma peritonei. Am J Surg 2002;183:529–32CrossRefPubMedGoogle Scholar
  30. 30.
    Glehen O, Osinsky D, Cotte E, et al. Intraperitoneal chemohyperthermia using a closed abdominal procedure and cytoreductive surgery for the treatment of peritoneal carcinomatosis: morbidity and mortality analysis of 216 consecutive procedures. Ann Surg Oncol 2003;10:863–9CrossRefPubMedGoogle Scholar
  31. 31.
    Pilati P, Mocellin S, Rossi CR, et al. Cytoreductive surgery combined with hyperthermic intraoperative intraperitoneal chemotherapy for peritoneal carcinomatosis arising from colon adenocarcinoma. Ann Surg Oncol 2003;10:508–13CrossRefPubMedGoogle Scholar
  32. 32.
    Shen P, Hawksworth J, Lovato J, et al. Cytoreductive surgery and intraperitoneal hyperthermic chemotherapy with mitomycin C for peritoneal carcinomatosis from nonappendiceal colorectal carcinoma. Ann Surg Oncol 2004;11:178–86PubMedGoogle Scholar
  33. 33.
    Ahmad SA, Kim J, Sussman JJ, et al. Reduced morbidity following cytoreductive surgery and intraperitoneal hyperthermic chemoperfusion. Ann Surg Oncol 2004;11:387–92PubMedGoogle Scholar
  34. 34.
    Verwaal VJ, van Tinteren H, Ruth SV, Zoetmulder FAN. Toxicity of cytoreductive surgery and hyperthermic intra-peritoneal chemotherapy. J Surg Oncol 2004;85:61–7CrossRefPubMedGoogle Scholar
  35. 35.
    Schmidt U, Dahlke MH, Klempnauer J, Schlitt HJ, Piso P. Perioperative morbidity and quality of life in long-term survivors following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Eur J Surg Oncol 2005; 31:53–8CrossRefPubMedGoogle Scholar
  36. 36.
    Kusamura S, Younan R, Baratti D, Costanzo P, Favaro M, Gavazzi C, Deraco M. Cytoreductive surgery followed by intraperitoneal hyperthermic perfusion. Analysis of morbidity and mortality in 209 peritoneal surface malignancies treated with closed abdomen technique. Cancer 2006; 106:1144–53CrossRefPubMedGoogle Scholar

Copyright information

© The Society of Surgical Oncology, Inc. 2006

Authors and Affiliations

  • Paul H. Sugarbaker
    • 1
  • Robert Alderman
    • 1
  • Gary Edwards
    • 1
  • Christina Ellen Marquardt
    • 1
  • Vadim Gushchin
    • 1
  • Jesus Esquivel
    • 1
  • David Chang
    • 2
  1. 1.Washington Cancer InstituteWashington
  2. 2.WestatRockville

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