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Annals of Surgical Oncology

, Volume 21, Issue 6, pp 1975–1982 | Cite as

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

  • Yarrow J. McConnell
  • Lloyd A. Mack
  • Xianyong Gui
  • Norman J. Carr
  • Lucas Sideris
  • Walley J. Temple
  • Pierre Dubé
  • Kandiah Chandrakumaran
  • Brendan J. Moran
  • Tom D. Cecil
Gastrointestinal Oncology

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.

Keywords

Overall Survival Peritoneal Metastasis Peritoneal Cancer Index Complete Cytoreduction Hyperthermic Intraperitoneal Chemotherapy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgment

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

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Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Yarrow J. McConnell
    • 1
  • Lloyd A. Mack
    • 1
  • Xianyong Gui
    • 2
  • Norman J. Carr
    • 3
  • Lucas Sideris
    • 4
  • Walley J. Temple
    • 1
  • Pierre Dubé
    • 4
  • Kandiah Chandrakumaran
    • 5
  • Brendan J. Moran
    • 5
  • Tom D. Cecil
    • 5
  1. 1.Division of Surgical Oncology, Tom Baker Cancer CentreUniversity of CalgaryCalgaryCanada
  2. 2.Department of Pathology and Laboratory MedicineUniversity of Calgary and Calgary Laboratory ServicesCalgaryCanada
  3. 3.Department of Cellular PathologyUniversity Hospital SouthamptonSouthamptonUK
  4. 4.Department of Surgery, Hôpital Maisonneuve-RosemontUniversité de MontréalMontrealCanada
  5. 5.Pseudomyxoma Peritonei CentreBasingstoke and North Hampshire Hospital Foundation TrustHampshireUK

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