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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 5/2019

01-05-2019 | Peritoneal Surface Malignancy

Pleuropulmonary Recurrence Following Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemoperfusion for Appendiceal Pseudomyxoma Peritonei

Authors: Joal D. Beane, MD, Gregory C. Wilson, MD, Jeffrey M. Sutton, MD, Yongli Shuai, PhD, Lekshmi Ramalingam, MD, Heather L. Jones, PA-C, James F. Pingpank II, MD, Matthew P. Holtzman, MD, Amer J. Zureikat, MD, Steven A. Ahrendt, MD, Herbert J. Zeh, MD, David L. Bartlett, MD, Haroon A. Choudry, MD

Published in: Annals of Surgical Oncology | Issue 5/2019

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Abstract

Background

The aim of this study was to identify factors associated with pleuropulmonary disease recurrence following cytoreductive surgery with hyperthermic intraperitoneal chemoperfusion (CRS/HIPEC) for appendiceal pseudomyxoma peritonei (PMP) and to evaluate the oncologic impact of pleuropulmonary disease recurrence compared with isolated peritoneal recurrence.

Methods

From a prospective database, we identified patients who developed pleuropulmonary recurrence, isolated peritoneal recurrence, or no recurrence following CRS/HIPEC for appendiceal PMP. Clinicopathologic, perioperative, and oncologic data associated with the index CRS/HIPEC procedure were reviewed. The Kaplan–Meier method was used to estimate survival. Multivariate analyses identified associations with recurrence and survival.

Results

Of 382 patients undergoing CRS/HIPEC, 61 (16%) developed pleuropulmonary recurrence. Patients who developed a pleuropulmonary recurrence were more likely to have high-grade (American Joint Committee on Cancer [AJCC] grade 2/3) tumors (74% vs. 56%, p = 0.02) and increased operative blood loss (1651 vs. 1201 ml, p = 0.05) and were more likely to have undergone diaphragm stripping/resection (79% vs. 48%, p < 0.01) compared with patients with an abdominal recurrence. In a multivariate analysis, pleuropulmonary recurrence after CRS/HIPEC was associated with diaphragm stripping/resection, incomplete cytoreduction, and higher AJCC tumor grade. There was a trend towards reduced survival in patients with pleuropulmonary recurrence compared with patients with isolated peritoneal recurrence (median overall survival 45 vs. 53 months, p = 0.87).

Conclusion

Pleuropulmonary recurrence of appendiceal PMP following CRS/HIPEC is common and may negatively impact survival. Formal protocols for surveillance and therapeutic intervention need to be studied and implemented to improve oncologic outcomes.
Literature
1.
. Moran B, Baratti D, Yan TD, Kusamura S, Deraco M. Consensus statement on the loco-regional treatment of appendiceal mucinous neoplasms with peritoneal dissemination (pseudomyxoma peritonei). J Surg Oncol. 2008;98(4):277–82.CrossRefPubMed
2.
Verwaal VJ, Bruin S, Boot H, van Slooten G, van Tinteren H. 8-year follow-up of randomized trial: cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy in patients with peritoneal carcinomatosis of colorectal cancer. Ann Surg Oncol. 2008;15(9):2426–32.CrossRefPubMed
3.
Chua TC, Moran BJ, Sugarbaker PH, Levine EA, Glehen O, Gilly FN, et al. Early- and long-term outcome data of patients with pseudomyxoma peritonei from appendiceal origin treated by a strategy of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. J Clin Oncol. 2012;30(20):2449–56.CrossRefPubMed
4.
Austin F, Mavanur A, Sathaiah M, Steel J, Lenzner D, Ramalingam L, et al. Aggressive management of peritoneal carcinomatosis from mucinous appendiceal neoplasms. Ann Surg Oncol. 2012;19(5):1386–93.CrossRefPubMedPubMedCentral
5.
Yan TD, Bijelic L, Sugarbaker PH. Critical analysis of treatment failure after complete cytoreductive surgery and perioperative intraperitoneal chemotherapy for peritoneal dissemination from appendiceal mucinous neoplasms. Ann Surg Oncol. 2007;14(8):2289–99.CrossRefPubMed
6.
Zoetmulder FA, Sugarbaker PH. Patterns of failure following treatment of pseudomyxoma peritonei of appendiceal origin. Eur J Cancer. 1996;32A(10):1727–33.CrossRefPubMed
7.
Chua TC, Liauw W, Morris DL. Early recurrence of pseudomyxoma peritonei following treatment failure of cytoreductive surgery and perioperative intraperitoneal chemotherapy is indicative of a poor survival outcome. Int J Colorectal Dis. 2012;27(3):381–9.CrossRefPubMed
8.
9.
Pestieau SR, Esquivel J, Sugarbaker PH. Pleural extension of mucinous tumor in patients with pseudomyxoma peritonei syndrome. Ann Surg Oncol. 2000;7(3):199–203.CrossRefPubMed
10.
Mortman KD, Sugarbaker PA, Shmookler BM, DeGuzman VC, Soberman MS. Pulmonary metastases in pseudomyxoma peritonei syndrome. Ann Thorac Surg. 1997;64(5):1434–6.CrossRefPubMed
11.
Geisinger KR, Levine EA, Shen P, Bradley RF. Pleuropulmonary involvement in pseudomyxoma peritonei: morphologic assessment and literature review. Am J Clin Pathol. 2007;127(1):135–43.CrossRefPubMed
12.
13.
Grotz TE, Mansfield PF, Royal RE, Mann GN, Rafeeq S, Beaty KA, et al. Intrathoracic chemoperfusion decreases recurrences in patients with full-thickness diaphragm involvement with mucinous appendiceal adenocarcinoma. Ann Surg Oncol. 2016;23(9):2914–9.CrossRefPubMed
14.
Khan AA, Tambiah J, Cane P, Lang-Lazdunski L. Prolonged survival in a patient with recurrent pulmonary metastases secondary to mucinous cystadenocarcinoma of the appendix with pseudomyxomatous peritonei. Ann Thorac Surg. 2007;83(5):1893–4.CrossRefPubMed
15.
Bao P, Bartlett D. Surgical techniques in visceral resection and peritonectomy procedures. Cancer J. 2009;15(3):204–11.CrossRefPubMed
16.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.CrossRefPubMedPubMedCentral
17.
Overman MJ, Asare EA, Compton CC, et al. Appendix—carcinoma. In: Amin MB, et al. editors. AJCC cancer staging manual. 8th ed. Chicago, IL: Springer; 2017. p. 237–50.CrossRef
18.
Sugarbaker PH, Chang D, Stuart OA. Hyperthermic intraoperative thoracoabdominal chemotherapy. Gastroenterol Res Pract. 2012;2012:623417.PubMedPubMedCentral
19.
Ahmed S, Levine EA, Randle RW, Swett KR, Shen P, Stewart JH, et al. Significance of diaphragmatic resections and thoracic chemoperfusion on outcomes of peritoneal surface disease treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Ann Surg Oncol. 2014;21(13):4226–31.CrossRefPubMedPubMedCentral
20.
Sardi A, Jimenez WA, Nieroda C, Sittig M, Macdonald R, Gushchin V. Repeated cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in peritoneal carcinomatosis from appendiceal cancer: analysis of survival outcomes. Eur J Surg Oncol. 2013;39(11):1207–13.CrossRefPubMed
21.
Wong JF, Tan GH, Wang W, Soo KC, Teo MC. Repeat cytoreductive surgery and hipec for peritoneal surface malignancy and peritoneal carcinomatosis. World J Surg. 2015;39(6):1578–83.CrossRefPubMed
22.
Baumgartner JM, Ahrendt SA, Pingpank JF, Holtzman MP, Ramalingam L, Jones HL, et al. Aggressive locoregional management of recurrent peritoneal sarcomatosis. J Surg Oncol. 2013;107(4):329–34.CrossRefPubMed
23.
Low RN, Barone RM, Lee MJ. Surveillance MR imaging is superior to serum tumor markers for detecting early tumor recurrence in patients with appendiceal cancer treated with surgical cytoreduction and HIPEC. Ann Surg Oncol. 2013;20(4):1074–81.CrossRefPubMed
24.
25.
Low RN. Preoperative and surveillance MR imaging of patients undergoing cytoreductive surgery and heated intraperitoneal chemotherapy. J Gastrointest Oncol. 2016;7(1):58–71.PubMedPubMedCentral
Metadata
Title
Pleuropulmonary Recurrence Following Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemoperfusion for Appendiceal Pseudomyxoma Peritonei
Authors
Joal D. Beane, MD
Gregory C. Wilson, MD
Jeffrey M. Sutton, MD
Yongli Shuai, PhD
Lekshmi Ramalingam, MD
Heather L. Jones, PA-C
James F. Pingpank II, MD
Matthew P. Holtzman, MD
Amer J. Zureikat, MD
Steven A. Ahrendt, MD
Herbert J. Zeh, MD
David L. Bartlett, MD
Haroon A. Choudry, MD
Publication date
01-05-2019
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 5/2019
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-018-07091-z

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