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01-04-2013 | Regional Cancer Therapies

Extensive Cytoreductive Surgery for Appendiceal Carcinomatosis: Morbidity, Mortality, and Survival

Authors: Patrick L. Wagner, MD, Frances Austin, MD, Ugwuji Maduekwe, MD, Arun Mavanur, MD, Lekshmi Ramalingam, MD, Heather L. Jones, PA, Matthew P. Holtzman, MD, Steven A. Ahrendt, MD, Amer H. Zureikat, MD, James F. Pingpank, MD, Herbert J. Zeh, MD, David L. Bartlett, MD, Haroon A. Choudry, MD

Published in: Annals of Surgical Oncology | Issue 4/2013

Abstract

Background

Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemoperfusion (HIPEC) are frequently used to treat appendiceal carcinomatosis. Some patients require multivisceral resection because of the volume of disease. It is unclear whether extent of CRS impacts survival in appendiceal carcinomatosis.

Methods

We analyzed 282 patients undergoing attempted CRS/HIPEC for appendiceal carcinomatosis. Patients were defined as having undergone Extensive CRS (n = 60) if they had >3 organ resections or >2 anastomoses; a subgroup of Extreme CRS patients (n = 10) had ≥5 organ resections and ≥3 anastomoses. Kaplan–Meier survival curves and multivariate Cox-regression models were used to identify prognostic factors affecting outcomes.

Results

Relative to the comparison group, patients undergoing Extensive CRS had a higher median peritoneal carcinomatosis index, operative duration, blood loss, and length of stay. No difference in completeness of cytoreduction, severe morbidity, or 60-day mortality was evident. Subgroup analysis of 10 patients undergoing extreme CRS likewise revealed no increase in severe morbidity or mortality. Median progression-free (PFS) and overall survival (OS) were 23.5 and 74 months in the comparison group; 18.5 (p = 0.086) and 51 (p = 0.85) months in the Extensive CRS group; and 40 months and not reached in the Extreme CRS subgroup. In a multivariable analysis, extent of CRS was not independently associated with PFS or OS.

Conclusions

Extensive CRS is associated with greater OR time, blood loss, and length of stay, but is not associated with higher morbidity, mortality, or inferior oncologic outcomes in patients with appendiceal carcinomatosis.

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Title: Extensive Cytoreductive Surgery for Appendiceal Carcinomatosis: Morbidity, Mortality, and Survival
Authors: Patrick L. Wagner, MD
Frances Austin, MD
Ugwuji Maduekwe, MD
Arun Mavanur, MD
Lekshmi Ramalingam, MD
Heather L. Jones, PA
Matthew P. Holtzman, MD
Steven A. Ahrendt, MD
Amer H. Zureikat, MD
James F. Pingpank, MD
Herbert J. Zeh, MD
David L. Bartlett, MD
Haroon A. Choudry, MD
Publication date: 01-04-2013
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 4/2013
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-012-2791-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Extensive Cytoreductive Surgery for Appendiceal Carcinomatosis: Morbidity, Mortality, and Survival

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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