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Timing of Repeat Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy for Recurrent Low-Grade Appendiceal Mucinous Neoplasms

  • Peritoneal Surface Malignancy
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Low-grade appendiceal mucinous neoplasm (LAMN) with peritoneal involvement is a common indication for cytoreductive surgery with heated intraperitoneal chemotherapy (CRS/HIPEC). With peritoneal recurrence, patients are increasingly being offered repeat CRS/HIPECs, however optimal timing for a second CRS/HIPEC remains unknown.

Methods

A prospectively maintained 30-year database at our high-volume HIPEC center was analyzed retrospectively for patients with LAMNs and peritoneal recurrence receiving one or two CRS/HIPECs. Kaplan–Meier survival analysis, linear regression modeling, and Cox proportional hazards regression analyses were performed.

Results

Overall, 143 patients with LAMNs who underwent CRS/HIPECs had confirmed postoperative peritoneal recurrence. Of these patients, 85 underwent one CRS/HIPEC and 58 underwent two CRS/HIPECs. The groups had significant differences in age, with younger patients more likely to undergo a second CRS/HIPEC (48.5 vs. 58.0 years; p < 0.001). The median overall survival (OS) for the group undergoing two CRS/HIPECs was approximately four times longer compared with the group undergoing one CRS/HIPEC (227.1 vs. 54.5 months; p < 0.0001). The time from recurrence to the second CRS/HIPEC was not significantly associated with OS from the time of the first operation. Instead, a shorter time between the first CRS/HIPEC and recurrence was significantly associated with shorter OS from the time of the first operation (p = 0.037).

Conclusion

In peritoneal LAMNs with recurrence, receiving two CRS/HIPECs was associated with better OS compared with receiving one CRS/HIPEC. Longer time to recurrence was a good prognostic factor. Delay between recurrence and second CRS/HIPEC had no apparent impact on OS from the first CRS/HIPEC; thus, immediate or delayed reoperative intervention are both reasonable approaches.

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Funding

This work was supported in part by The Smith Family Fund and the Wake Forest University Comprehensive Cancer Center Biostatistics Shared Resource funded via the NCI grant award P30CA012197.

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Authors and Affiliations

  1. Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA

    Cristian D. Valenzuela MD, Christopher W. Mangieri MD, Mary Garland-Kledzik MD, Rohin Gawdi BA, Kathleen C. Perry BS, Konstantinos I. Votanopoulos MD, PhD, Edward A. Levine MD & Perry Shen MD

  2. Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA

    Gregory Russell BS, MS

Authors
  1. Cristian D. Valenzuela MD
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  2. Christopher W. Mangieri MD
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  3. Mary Garland-Kledzik MD
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  4. Rohin Gawdi BA
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  5. Gregory Russell BS, MS
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  6. Kathleen C. Perry BS
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  7. Konstantinos I. Votanopoulos MD, PhD
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  8. Edward A. Levine MD
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  9. Perry Shen MD
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Correspondence to Perry Shen MD.

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Disclosures

Cristian D. Valenzuela, Christopher W. Mangieri, Mary Garland-Kledzik, Rohin Gawdi, Gregory Russell, Kathleen C. Perry, Konstantinos I. Votanopoulos, Edward A. Levine, and Perry Shen declare no conflicts of interest.

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Valenzuela, C.D., Mangieri, C.W., Garland-Kledzik, M. et al. Timing of Repeat Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy for Recurrent Low-Grade Appendiceal Mucinous Neoplasms. Ann Surg Oncol 29, 3422–3431 (2022). https://doi.org/10.1245/s10434-022-11440-4

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  • DOI: https://doi.org/10.1245/s10434-022-11440-4

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