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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 13/2014

01-12-2014 | Gastrointestinal Oncology

Predictive and Prognostic Survival Factors in Peritoneal Carcinomatosis from Appendiceal Cancer After Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy

Authors: William Jimenez, MD, Armando Sardi, MD, FACS, Carol Nieroda, MD, Michelle Sittig, RN, Vladimir Milovanov, MD, Maria Nunez, MD, Nail Aydin, MD, Vadim Gushchin, MD, FACS

Published in: Annals of Surgical Oncology | Issue 13/2014

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Abstract

Background

Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) has survival benefit in the treatment of selected patients with peritoneal carcinomatosis (PC) from appendiceal cancer (AC). We evaluated factors affecting the survival of patients with PC from AC after CRS/HIPEC.

Methods

A retrospective analysis of 387 CRS/HIPEC procedures performed between February 1998 and February 2013 identified 202 patients with PC from AC. Tumor histopathology, complete cytoreduction (CC 0–1), Peritoneal Cancer Index (PCI), and lymph node (LN) status were related to overall survival (OS) and progression-free survival (PFS) using the Kaplan–Meier method.

Results

Overall, 129 women (64 %) and 73 men (36 %), mean age 54 years (range 25–81), with a mean follow-up of 36 months were included in the study. Seventy-seven low-grade tumors (disseminated peritoneal adenomucinosis [DPAM]; 38 %) and 125 high-grade tumors (peritoneal mucinous carcinomatosis [PMCA]; 62 %) were identified. Five- and 10-year OS was 56 % and 47 %, respectively, with PFS of 44 % at 5 and 10 years. Five-year OS in DPAM patients was 83 %, with a 5-year OS significant difference related to CC 0–1 versus CC 2–3 (incomplete cytoreduction) [p = 0.021]. Five-year OS in PMCA patients was 41 %, with a 5-year OS significant difference related to CC 0–1 versus CC 2–3 (p < 0.001), PCI <20 versus PCI ≥20 (p = 0.002), and (–)LN versus (+)LN (p < 0.001). Grade III/IV complications were 16 %. No perioperative mortality was reported.

Conclusion

Positive LN, PMCA histopathology, and PCI ≥20 are negative prognostic factors, while CC 0–1 is a positive survival predictor in PC from AC treated with CRS/HIPEC. However, in patients with PMCA and PCI ≥20 in whom CC 0–1 was a potential outcome should not be denied CRS/HIPEC.
Appendix
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Metadata
Title
Predictive and Prognostic Survival Factors in Peritoneal Carcinomatosis from Appendiceal Cancer After Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy
Authors
William Jimenez, MD
Armando Sardi, MD, FACS
Carol Nieroda, MD
Michelle Sittig, RN
Vladimir Milovanov, MD
Maria Nunez, MD
Nail Aydin, MD
Vadim Gushchin, MD, FACS
Publication date
01-12-2014
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 13/2014
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-014-3869-1

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