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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 12/2023

26-08-2023 | Cytostatic Therapy | Peritoneal Surface Malignancy

Patterns of Recurrence in Appendix Cancer After Complete Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy

Authors: Andrei Nikiforchin, MD, Armando Sardi, MD, FACS, Mary Caitlin King, BS, Ekaterina Baron, MD, Felipe Lopez-Ramirez, MD, Luis Felipe Falla-Zuniga, MD, Philipp Barakat, MD, Sergei Iugai, MD, Kathleen Pawlikowski, BA, Carol Nieroda, MD, Vadim Gushchin, MD, FACS

Published in: Annals of Surgical Oncology | Issue 12/2023

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Abstract

Background

It is thought that low-grade (LG) appendiceal cancer (AC) demonstrates predominantly intraperitoneal recurrence (IPR) after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC), whereas high-grade (HG) tumors progress both intra- and extraperitoneally (EPR). However, evidence supporting this conception is lacking; therefore, we assessed recurrence in various AC histologies.

Methods

A retrospective, cohort study was conducted by using a single-center database (1998–2022). Recurrence patterns (IPR, EPR, combined) were identified for LG, HG, high-grade with signet ring cells (SRC), and goblet cell carcinoma (GCC).

Results

We included 432 complete (CC-0/1) CRS/HIPECs: 200 LG, 114 HG, 72 SRC, and 46 GCC. Median follow-up was 78 (95% confidence interval [CI] 70–86) months. Overall, 34% (n = 148) of patients recurred. IPR was the most common (LG 16%, HG 27%, SRC 36%, GCC 26%) with median time to recurrence (MTR) of 21 (IQR: 12–40) months. EPR (liver, lung, pleura, lymph nodes, or bones) occurred in LG 3%, HG 9%, SRC 22%, and GCC 7%. MTR was 11 (IQR: 4–16) months. Combined pattern occurred in LG 0%, HG 8%, SRC 7%, and GCC 0%. MTR was 13 (IQR: 7–18) months. Iterative surgery was performed in 53% IPR, 18% EPR, and 51% combined. Median post-recurrence survival was longer after IPR compared with EPR and combined recurrence: 36 (95% CI 25–47) versus 13 (95% CI 7–19) and 18 (95% CI 6–30) months (p < 0.01).

Conclusions

After complete CRS/HIPEC, IPR was the predominant pattern in all AC histologies and occurred later. Post-recurrence survival after IPR was longer. Knowing AC recurrence patterns can help to understand its biology and plan follow-up and post-relapse management.
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Metadata
Title
Patterns of Recurrence in Appendix Cancer After Complete Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy
Authors
Andrei Nikiforchin, MD
Armando Sardi, MD, FACS
Mary Caitlin King, BS
Ekaterina Baron, MD
Felipe Lopez-Ramirez, MD
Luis Felipe Falla-Zuniga, MD
Philipp Barakat, MD
Sergei Iugai, MD
Kathleen Pawlikowski, BA
Carol Nieroda, MD
Vadim Gushchin, MD, FACS
Publication date
26-08-2023
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 12/2023
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-023-14145-4

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