Peritoneal Carcinomatosis from Appendiceal Cancer: Early Adequate Therapeutic Management for Long-Term Survival

Excerpt

Epithelial appendiceal cancers are unusual, and nearly all patients with these tumors have peritoneal dissemination at the time of diagnosis.1 Most of them have no lymphatic or hematogeneous metastases, as has been reported by Chua et al.2 The site of treatment failure included the abdomen alone in 48% of patients, and only 4% developed distant metastatic site alone. Thus, there is a strong rationale for extensive locoregional treatment combining cytoreductive surgery and perioperative intraperitoneal chemotherapy to treat a locoregional disease. Long-term survival has already been reported for peritoneal dissemination of various etiologies treated with this aggressive but comprehensive combined therapeutic approach.3 Among all these etiologies, peritoneal carcinomatosis from appendiceal cancers represents one with the best prognosis, with 5-year survival rates ranging 45–65% with appropriate therapeutic management.2,3 Elias et al., in a French multi-institutional study, demonstrated that locoregional treatment for appendiceal cancers was better than for colon, rectum, and small bowel adenocarcinoma.4 The characteristics and the extent of the disease were similar to those of tumors of other origins, signifying that the diagnosis of carcinomatosis from appendiceal tumors was not earlier. The site of recurrence was not recorded in their study. The prognosis difference in favor of appendiceal cancers may be explained by a lower risk of systemic or metastatic dissemination, as well as a possible different biologic behavior. Regarding the interesting long-term survival results already reported and confirmed by Chua et al. for this unusual disease, the combined approach should become the gold standard treatment of peritoneal carcinomatosis from appendiceal cancer.2 …