Annals of Surgical Oncology

, Volume 15, Issue 10, pp 2701–2708 | Cite as

Hyperthermic Intraperitoneal Chemotherapy with Oxaliplatin for Peritoneal Carcinomatosis Arising from Appendix: Preliminary Results of a Survival Analysis

  • Eric Marcotte
  • Lucas Sideris
  • Pierre Drolet
  • Andrew Mitchell
  • Suzanne Frenette
  • Guy Leblanc
  • Yves E. Leclerc
  • Pierre Dubé
Gastrointestinal Oncology

Abstract

Background

Peritoneal carcinomatosis (PC) arising from the appendix is a rare disease for which the long-term prognosis is poor. The aim of this study was to evaluate the results of an aggressive approach used in our institution over the last 5 years.

Methods

Data from all patients with PC arising from the appendix were prospectively collected and analyzed. Treatment consisted in complete surgical cytoreduction followed by hyperthermic intraperitoneal chemotherapy (HIPEC) with oxaliplatin (460 mg/m2) in 2 L/m2 of D5W at 43°C during 30 min. Ronnett’s histologic classification was used for tumor grading.

Results

From February 2003 to March 2007, 38 patients with PC arising from the appendix underwent laparotomy with curative intent. Mean follow-up was 23 months. Twenty-three patients received HIPEC but ten patients could not have complete cytoreductive surgery and received no HIPEC. Five patients with a negative second-look surgery also received no HIPEC. Three-year overall survival (OS) was 100% for the negative second-look patients, 86% for the HIPEC patients, and 29% for the unresectable patients (P = 0.0098). Three-year disease-free survival (DFS) was 49% for the HIPEC patients. Histologic grade was a prognostic factor with regard to DFS for the HIPEC patients (P = 0.011). There was one postoperative mortality. The overall major (grade III–V/V) complication rate for treated patients was 39%, including intra-abdominal abscess (22%), hemorrhage (18%), and anastomotic leak (9%).

Conclusion

Although these results are preliminary, this therapeutic approach seems both feasible and safe in selected patients.

Keywords

Peritoneal neoplasms Appendiceal neoplasms Hyperthermic intraperitoneal chemotherapy Oxaliplatin 

References

  1. 1.
    McCusker ME, Cote TR, Clegg LX, et al. Primary malignant neoplasms of the appendix: a population-based study from the surveillance, epidemiology and end-results program, 1973–1998. Cancer 2002;94:3307–12PubMedCrossRefGoogle Scholar
  2. 2.
    Connor SJ, Hanna GB, Frizelle FA. Appendiceal tumors: retrospective clinicopathologic analysis of appendiceal tumors from 7,970 appendectomies. Dis Colon Rectum 1998;41:75–80PubMedCrossRefGoogle Scholar
  3. 3.
    Ronnett BM, Yan H, Kurman RJ, et al. Patients with pseudomyxoma peritonei associated with disseminated peritoneal adenomucinosis have a significantly more favorable prognosis than patients with peritoneal mucinous carcinomatosis. Cancer 2001;92:85–91PubMedCrossRefGoogle Scholar
  4. 4.
    Smeenk RM, Verwaal VJ, Zoetmulder FA. Pseudomyxoma peritonei. Cancer Treat Rev 2007;33:138–45PubMedCrossRefGoogle Scholar
  5. 5.
    Gough DB, Donohue JH, Schutt AJ, et al. Pseudomyxoma peritonei. Long-term patient survival with an aggressive regional approach. Ann Surg 1994;219:112–9PubMedCrossRefGoogle Scholar
  6. 6.
    Miner TJ, Shia J, Jaques DP, et al. Long-term survival following treatment of pseudomyxoma peritonei: an analysis of surgical therapy. Ann Surg 2005;241:300–8PubMedCrossRefGoogle Scholar
  7. 7.
    Spratt JS, Adcock RA, Muskovin M, et al. Clinical delivery system for intraperitoneal hyperthermic chemotherapy. Cancer Res 1980;40:256–60PubMedGoogle Scholar
  8. 8.
    Gonzalez-Moreno S, Sugarbaker PH. Right hemicolectomy does not confer a survival advantage in patients with mucinous carcinoma of the appendix and peritoneal seeding. Br J Surg 2004;91:304–11PubMedCrossRefGoogle Scholar
  9. 9.
    Elias D, Laurent S, Antoun S, et al. [Pseudomyxoma peritonei treated with complete resection and immediate intraperitoneal chemotherapy]. Gastroenterol Clin Biol 2003;27:407–12PubMedGoogle Scholar
  10. 10.
    Guner Z, Schmidt U, Dahlke MH, et al. Cytoreductive surgery and intraperitoneal chemotherapy for pseudomyxoma peritonei. Int J Colorectal Dis 2005;20:155–60PubMedCrossRefGoogle Scholar
  11. 11.
    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;48:1372–9PubMedCrossRefGoogle Scholar
  12. 12.
    Murphy EM, Sexton R, Moran BJ. Early results of surgery in 123 patients with pseudomyxoma peritonei from a perforated appendiceal neoplasm. Dis Colon Rectum 2007;50:37–42PubMedCrossRefGoogle Scholar
  13. 13.
    Smeenk RM, Verwaal VJ, Antonini N, et al. Survival analysis of pseudomyxoma peritonei patients treated by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Ann Surg 2007;245:104–9PubMedCrossRefGoogle Scholar
  14. 14.
    Stewart JHt, Shen P, Russell GB, et al. Appendiceal neoplasms with peritoneal dissemination: outcomes after cytoreductive surgery and intraperitoneal hyperthermic chemotherapy. Ann Surg Oncol 2006;13:624–34PubMedCrossRefGoogle Scholar
  15. 15.
    Sugarbaker PH, Chang D. Results of treatment of 385 patients with peritoneal surface spread of appendiceal malignancy. Ann Surg Oncol 1999;6:727–31PubMedCrossRefGoogle Scholar
  16. 16.
    Yan TD, Links M, Xu ZY, et al. Cytoreductive surgery and perioperative intraperitoneal chemotherapy for pseudomyxoma peritonei from appendiceal mucinous neoplasms. Br J Surg 2006;93:1270–6PubMedCrossRefGoogle Scholar
  17. 17.
    Yan TD, Black D, Savady R, et al. A systematic review on the efficacy of cytoreductive surgery and perioperative intraperitoneal chemotherapy for pseudomyxoma peritonei. Ann Surg Oncol 2007;14:484–92PubMedCrossRefGoogle Scholar
  18. 18.
    Baratti D, Kusamura S, Nonaka D, et al. Pseudomyxoma peritonei: clinical pathological and biological prognostic factors in patients treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC). Ann Surg Oncol 2008;15:526–34PubMedCrossRefGoogle Scholar
  19. 19.
    Yan TD, Bijelic L, Sugarbaker PH. Critical analysis of treatment failure after complete cytoreductive surgery and perioperative intraperitoneal chemotherapy for peritoneal dissemination from appendiceal mucinous neoplasms. Ann Surg Oncol 2007;14:2289–99PubMedCrossRefGoogle Scholar
  20. 20.
    Sugarbaker PH. Laboratory and clinical basis for hyperthermia as a component of intracavitary chemotherapy. Int J Hyperthermia 2007;23:431–42PubMedCrossRefGoogle Scholar
  21. 21.
    Urano M, Kuroda M, Nishimura Y. For the clinical application of thermochemotherapy given at mild temperatures. Int J Hyperthermia 1999;15:79–107PubMedCrossRefGoogle Scholar
  22. 22.
    Los G, Smals OA, van Vugt MJ, et al. A rationale for carboplatin treatment and abdominal hyperthermia in cancers restricted to the peritoneal cavity. Cancer Res 1992;52:1252–8PubMedGoogle Scholar
  23. 23.
    Jacquet P, Averbach A, Stephens AD, et al. Heated intraoperative intraperitoneal mitomycin C and early postoperative intraperitoneal 5-fluorouracil: pharmacokinetic studies. Oncology 1998;55:130–8PubMedCrossRefGoogle Scholar
  24. 24.
    Rietbroek RC, van de Vaart PJ, Haveman J, et al. Hyperthermia enhances the cytotoxicity and platinum-DNA adduct formation of lobaplatin and oxaliplatin in cultured SW 1573 cells. J Cancer Res Clin Oncol 1997;123:6–12PubMedCrossRefGoogle Scholar
  25. 25.
    Elias D, Bonnay M, Puizillou JM, et al. Heated intra-operative intraperitoneal oxaliplatin after complete resection of peritoneal carcinomatosis: pharmacokinetics and tissue distribution. Ann Oncol 2002;13:267–72PubMedCrossRefGoogle Scholar
  26. 26.
    Elias D, Sideris L, Pocard M, et al. Efficacy of intraperitoneal chemohyperthermia with oxaliplatin in colorectal peritoneal carcinomatosis. Preliminary results in 24 patients. Ann Oncol 2004;15:781–5PubMedCrossRefGoogle Scholar
  27. 27.
    Sugarbaker PH. Intraperitoneal chemotherapy and cytoreductive surgery for the prevention and treatment of peritoneal carcinomatosis and sarcomatosis. Semin Surg Oncol 1998;14:254–61PubMedCrossRefGoogle Scholar
  28. 28.
    Sugarbaker PH. Peritonectomy procedures. Ann Surg 1995;221:29–42PubMedCrossRefGoogle Scholar
  29. 29.
    Jacquet P, Sugarbaker PH. Clinical research methodologies in diagnosis and staging of patients with peritoneal carcinomatosis. Cancer Treat Res 1996;82:359–74PubMedGoogle Scholar
  30. 30.
    Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205–13PubMedCrossRefGoogle Scholar
  31. 31.
    Smeenk RM, Verwaal VJ, Zoetmulder FA. Toxicity and mortality of cytoreduction and intraoperative hyperthermic intraperitoneal chemotherapy in pseudomyxoma peritonei—a report of 103 procedures. Eur J Surg Oncol 2006;32:186–90PubMedCrossRefGoogle Scholar
  32. 32.
    Sugarbaker PH, Alderman R, Edwards G, et al. Prospective morbidity and mortality assessment of cytoreductive surgery plus perioperative intraperitoneal chemotherapy to treat peritoneal dissemination of appendiceal mucinous malignancy. Ann Surg Oncol 2006;13:635–44PubMedCrossRefGoogle Scholar
  33. 33.
    Glehen O, Mohamed F, Sugarbaker PH. Incomplete cytoreduction in 174 patients with peritoneal carcinomatosis from appendiceal malignancy. Ann Surg 2004;240:278–85PubMedCrossRefGoogle Scholar
  34. 34.
    Esquivel J, Sugarbaker PH. Second-look surgery in patients with peritoneal dissemination from appendiceal malignancy: analysis of prognostic factors in 98 patients. Ann Surg 2001;234:198–205PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2008

Authors and Affiliations

  • Eric Marcotte
    • 1
  • Lucas Sideris
    • 1
  • Pierre Drolet
    • 2
  • Andrew Mitchell
    • 3
  • Suzanne Frenette
    • 4
  • Guy Leblanc
    • 1
  • Yves E. Leclerc
    • 1
  • Pierre Dubé
    • 1
  1. 1.Division of General Surgical Oncology, Department of SurgeryHôpital Maisonneuve-Rosemont, Université de MontréalMontréalCanada
  2. 2.Department of AnesthesiologyHopital Maisonneuve-Rosemont, Université de MontréalMontréalCanada
  3. 3.Department of PathologyHopital Maisonneuve-Rosemont, Université de MontréalMontréalCanada
  4. 4.Department of PharmacyHopital Maisonneuve-Rosemont, Université de MontréalMontréalCanada

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