International Journal of Clinical Oncology

, Volume 23, Issue 2, pp 298–304 | Cite as

Repeat cytoreduction and hyperthermic intraperitoneal chemotherapy for recurrent peritoneal carcinomatosis of appendiceal origin

  • Toshiyuki KitaiEmail author
  • Kenya Yamanaka
Original Article



The purpose of this study was to clarify the role of repeat cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) in the management of recurrent peritoneal carcinomatosis of appendiceal origin.


Data were retrieved on 42 patients who underwent CRS + HIPEC; 29 repeat surgical procedures were performed in 13 patients.


Complete cytoreduction was achieved in 12 of 13 patients by the second CRS. Repeat recurrence was detected in 11 patients, eight of whom underwent a third CRS. The peritoneal cancer index decreased from initial CRS to repeat CRS but was still higher than 18 in nine patients at the second CRS. Preoperative chemotherapy was given to three patients with early recurrence. Grade 3–5 morbidity and 90-day mortality were not significantly different between initial and repeat CRS. Five-year survival rates after first and second CRS were 75.5 and 67.7%, respectively. Complete cytoreduction at second CRS was a significant prognostic factor. Among patients with recurrence after the second CRS, patients who underwent a third CRS showed a better prognosis than those who did not.


Repeat CRS is oncologically beneficial, and the morbidity rate was as high as that of initial CRS. Complete cytoreduction was the key to successful long-term results. Although further recurrence was common, aggressive resection was useful, even in cases of diffuse recurrence.


Repeat cytoreductive surgery Appendiceal cancer Diffuse recurrence Small intestine Multidisciplinary approach Third procedure 



The authors thank Prof. Takayoshi Hirai, Fukui Prefectural University, for confirming that methods of statistical analysis were correct.


The authors have no organization that funded our research.

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest in association with this study.


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Copyright information

© Japan Society of Clinical Oncology 2017

Authors and Affiliations

  1. 1.Department of SurgeryKishiwada City HospitalKishiwadaJapan

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