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Aggressive Management of Peritoneal Carcinomatosis from Mucinous Appendiceal Neoplasms

  • Regional Cancer Therapies
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Peritoneal carcinomatosis (PC) in the setting of mucinous appendiceal neoplasms is characterized by the intraperitoneal accumulation of mucinous ascites and mucin-secreting epithelial cells that leads to progressive compression of intra-abdominal organs, morbidity, and eventual death. We assessed postoperative and oncologic outcomes after aggressive surgical management by experienced surgeons.

Methods

We analyzed clinicopathologic, perioperative, and oncologic outcome data in 282 patients with PC from appendiceal adenocarcinomas between 2001 and 2010 from a prospective database. Kaplan–Meier survival curves and multivariate Cox-regression models were used to identify prognostic factors affecting oncologic outcomes.

Results

Adequate cytoreduction was achieved in 82% of patients (completeness of cytoreduction score (CC)-0: 49%; CC-1: 33%). Median simplified peritoneal cancer index (SPCI), operative time, and estimated blood loss were 14 (range, 0–21), 483.5 min (range, 46–1,402), and 800 ml (range, 0–14,000), respectively. Pathology assessment demonstrated high-grade tumors in 36% of patients and lymph node involvement in 23% of patients. Major postoperative morbidity occurred in 70 (25%) patients. Median overall survival was 6.72 years (95% confidence interval (CI), 4.17 years not reached), with 5 year overall survival probability of 52.7% (95% CI, 42.4, 62%). In a multivariate Cox-regression model, tumor grade, age, preoperative SPCI and chemo-naïve status at surgery were joint significant predictors of overall survival. Tumor grade, postoperative CC-score, prior chemotherapy, and preoperative SPCI were joint significant predictors of time to progression.

Conclusions

Aggressive management of PC from mucinous appendiceal neoplasms, by experienced surgeons, to achieve complete cytoreduction provides long-term survival with low major morbidity.

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Authors and Affiliations

  1. Division of Surgical Oncology, University of Pittsburgh, Pittsburgh, PA, USA

    Frances Austin MD, Arun Mavanur MD, Magesh Sathaiah, Lekshmi Ramalingam MD, Matthew Holtzman MD, Steven Ahrendt MD, James Pingpank MD, Herbert J. Zeh MD, David L. Bartlett MD & Haroon A. Choudry MD

  2. Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA

    Jennifer Steel PhD

  3. Biostatistics Facility, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA

    Diana Lenzner MS

  4. 5150 Center Avenue, Suite 414, Pittsburgh, PA, USA

    David L. Bartlett MD & Haroon A. Choudry MD

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  1. Frances Austin MD
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  2. Arun Mavanur MD
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  3. Magesh Sathaiah
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  4. Jennifer Steel PhD
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  5. Diana Lenzner MS
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  6. Lekshmi Ramalingam MD
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  7. Matthew Holtzman MD
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  8. Steven Ahrendt MD
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  9. James Pingpank MD
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  10. Herbert J. Zeh MD
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  11. David L. Bartlett MD
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  12. Haroon A. Choudry MD
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Corresponding authors

Correspondence to David L. Bartlett MD or Haroon A. Choudry MD.

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Austin, F., Mavanur, A., Sathaiah, M. et al. Aggressive Management of Peritoneal Carcinomatosis from Mucinous Appendiceal Neoplasms. Ann Surg Oncol 19, 1386–1393 (2012). https://doi.org/10.1245/s10434-012-2241-6

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  • DOI: https://doi.org/10.1245/s10434-012-2241-6

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