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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 11/2015

Open Access 01-10-2015 | Gastrointestinal Oncology

A Simplified Preoperative Assessment Predicts Complete Cytoreduction and Outcomes in Patients with Low-Grade Mucinous Adenocarcinoma of the Appendix

Authors: Sean P. Dineen, Richard E. Royal, Marybeth S. Hughes, Tara Sagebiel, Priya Bhosale, Michael Overman, Aurelio Matamoros, Paul F. Mansfield, Keith F. Fournier

Published in: Annals of Surgical Oncology | Issue 11/2015

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Abstract

Background

Complete cytoreduction with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) has been shown to improve survival in patients with low-grade mucinous adenocarcinoma (LGMA). However, incomplete cytoreduction exposes patients to significant morbidity without a similar survival benefit. Preoperative assessment of the ability to achieve CRS is therefore a critical step in selecting patients for CRS/HIPEC.

Objective

The aim of this study was to develop and validate a preoperative scoring system to accurately predict the ability to achieve complete cytoreduction in patients with LGMA of the appendix.

Methods

A simplified preoperative assessment for appendix tumor (SPAAT) score was developed based on computed tomography scan findings thought to predict incomplete cytoreduction. We applied the SPAAT score to patients with LGMA to determine the ability of the score to predict complete cytoreduction. This scoring system was then applied to a separate cohort of patients from a different institution. Sensitivity and specificity were determined for the SPAAT score. Survival was calculated and correlated with the SPAAT score and the completeness of cytoreduction score.

Results

A SPAAT score of <3 is a significant predictor of complete cytoreduction in the derivation cohort. In the validation cohort, 40 of 42 patients with a SPAAT score <3 achieved a complete cytoreduction, for a positive predictive value of 95.2 % and a negative predictive value of 100 %. Additionally, the SPAAT score was a significant predictor of disease-free survival.

Conclusions

The SPAAT score is a useful tool in the preoperative assessment of patients with LGMA who are under consideration for cytoreductive surgery. Prospective analysis of this scoring system is warranted to appropriately select patients who will benefit from CRS/HIPEC.
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Metadata
Title
A Simplified Preoperative Assessment Predicts Complete Cytoreduction and Outcomes in Patients with Low-Grade Mucinous Adenocarcinoma of the Appendix
Authors
Sean P. Dineen
Richard E. Royal
Marybeth S. Hughes
Tara Sagebiel
Priya Bhosale
Michael Overman
Aurelio Matamoros
Paul F. Mansfield
Keith F. Fournier
Publication date
01-10-2015
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 11/2015
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-015-4446-y

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