Outcomes of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemoperfusion in Patients with High-Grade, High-Volume Disseminated Mucinous Appendiceal Neoplasms
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High-grade (HG) mucinous appendiceal neoplasms (MAN) have a worse prognosis than low-grade histology. Our objective was to assess the safety and efficacy of cytoreductive surgery with hyperthermic intraperitoneal chemoperfusion (CRS/HIPEC) in patients with high-grade, high-volume (HG–HV) peritoneal metastases in whom the utility of this aggressive approach is controversial.
Prospectively collected perioperative data were compared between patients with peritoneal metastases from HG–HV MAN, defined as simplified peritoneal cancer index (SPCI) ≥12, and those with high-grade, low-volume (HG–LV; SPCI <12) disease. Kaplan–Meier curves and multivariate Cox regression models identified prognostic factors affecting oncologic outcomes.
Overall, 54 patients with HG–HV and 43 with HG–LV peritoneal metastases underwent CRS/HIPEC. The HG–HV group had longer operative time, increased blood loss/transfusion, and increased intensive care unit length of stay (p < 0.05). Incomplete macroscopic cytoreduction (CC-1/2/3) was higher in the HG–HV group compared with the HG–LV group (68.5 vs. 32.6 %; p = 0.005). Patients with HG–HV disease demonstrated worse survival than those with HG–LV disease (overall survival [OS] 17 vs. 42 m, p = 0.009; time to progression (TTP) 10 vs. 14 m, p = 0.024). However, when complete macroscopic resection (CC-0) was achieved, the OS and progression-free survival of patients with HG–HV disease were comparable with HG–LV disease (OS 56 vs. 52 m, p = 0.728; TTP 20 vs. 19 m, p = 0.393). In a multivariate Cox proportional hazard regression model, CC-0 resection was the only significant predictor of improved survival for patients with HG–HV disease.
Although patients with HG–HV peritoneal metastases from MAN have worse prognosis compared with patients with HG–LV disease, their survival is comparable when complete macroscopic cytoreduction is achieved.
KeywordsOverall Survival Peritoneal Metastasis Complete Cytoreduction Residual Macroscopic Tumor Complete Macroscopic Resection
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