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Outcomes of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemoperfusion in Patients with High-Grade, High-Volume Disseminated Mucinous Appendiceal Neoplasms

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

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References

  1. Austin F, Mavanur A, Sathaiah M, et al. Aggressive management of peritoneal carcinomatosis from mucinous appendiceal neoplasms. Ann Surg Oncol. 2012;19:1386–93.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Sugarbaker PH. New standard of care for appendiceal epithelial neoplasms and pseudomyxoma peritonei syndrome? Lancet Oncol. 2006;7:69–76.

    Article  PubMed  Google Scholar 

  3. Polanco PM, Ding Y, Knox JM, et al. Institutional learning curve of cytoreductive surgery and hyperthermic intraperitoneal chemoperfusion for peritoneal malignancies. Ann Surg Oncol. 2015;22:1673–9.

    Article  PubMed  Google Scholar 

  4. Polanco PM, Sanchez AI, Ramalingam L, et al. Does obesity affect outcomes of cytoreductive surgery and hyperthermic intraperitoneal chemoperfusion for disseminated mucinous appendiceal neoplasms? Ann Surg Oncol. 2014;21:3963–9.

    Article  PubMed  Google Scholar 

  5. Chua TC, Moran BJ, Sugarbaker PH, 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;30:2449–56.

    Article  PubMed  Google Scholar 

  6. Elias D, Honore C, Ciuchendea R, et al. Peritoneal pseudomyxoma: results of a systematic policy of complete cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Br J Surg. 2008;95:1164–71.

    Article  PubMed  CAS  Google Scholar 

  7. Levine EA, Stewart JH 4th, Russell GB, et al. Cytoreductive surgery and intraperitoneal hyperthermic chemotherapy for peritoneal surface malignancy: experience with 501 procedures. J Am Coll Surg. 2007;204:943–53; discussion 953–5

    Article  PubMed  Google Scholar 

  8. Loungnarath R, Causeret S, Bossard N, et al. Cytoreductive surgery with intraperitoneal chemohyperthermia for the treatment of pseudomyxoma peritonei: a prospective study. Dis Colon Rectum. 2005;48:1372–9.

    Article  PubMed  Google Scholar 

  9. Omohwo C, Nieroda CA, Studeman KD, et al. Complete cytoreduction offers longterm survival in patients with peritoneal carcinomatosis from appendiceal tumors of unfavorable histology. J Am Coll Surg. 2009;209:308–12.

    Article  PubMed  Google Scholar 

  10. Smeenk RM, Verwaal VJ, Antonini N, et al. Survival analysis of pseudomyxoma peritonei patients treated by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Ann Surg. 2007;245:104–9.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Stewart JH 4th, Shen P, Russell GB, et al. Appendiceal neoplasms with peritoneal dissemination: outcomes after cytoreductive surgery and intraperitoneal hyperthermic chemotherapy. Ann Surg Oncol. 2006;13:624–34.

    Article  PubMed  Google Scholar 

  12. Sugarbaker PH, Alderman R, Edwards G, et al. Prospective morbidity and mortality assessment of cytoreductive surgery plus perioperative intraperitoneal chemotherapy to treat peritoneal dissemination of appendiceal mucinous malignancy. Ann Surg Oncol. 2006;13:635–44.

    Article  PubMed  Google Scholar 

  13. Yan TD, Black D, Savady R, et al. A systematic review on the efficacy of cytoreductive surgery and perioperative intraperitoneal chemotherapy for pseudomyxoma peritonei. Ann Surg Oncol. 2007;14:484–92.

    Article  PubMed  Google Scholar 

  14. Yan TD, Links M, Xu ZY, et al. Cytoreductive surgery and perioperative intraperitoneal chemotherapy for pseudomyxoma peritonei from appendiceal mucinous neoplasms. Br J Surg. 2006;93:1270–6.

    Article  PubMed  CAS  Google Scholar 

  15. Sugarbaker PH. Epithelial appendiceal neoplasms. Cancer J. 2009;15:225–35.

    Article  PubMed  Google Scholar 

  16. Bradley RF, Stewart JH 4th, Russell GB, et al. Pseudomyxoma peritonei of appendiceal origin: a clinicopathologic analysis of 101 patients uniformly treated at a single institution, with literature review. Am J Surg Pathol. 2006;30:551–9.

    Article  PubMed  Google Scholar 

  17. Carr NJ, Finch J, Ilesley IC, et al. Pathology and prognosis in pseudomyxoma peritonei: a review of 274 cases. J Clin Pathol. 2012;65:919–23.

    Article  PubMed  Google Scholar 

  18. Davison JM, Choudry HA, Pingpank JF, et al. Clinicopathologic and molecular analysis of disseminated appendiceal mucinous neoplasms: identification of factors predicting survival and proposed criteria for a three-tiered assessment of tumor grade. Mod Pathol. 2014;27:1521–39.

    Article  PubMed  Google Scholar 

  19. Misdraji J. Appendiceal mucinous neoplasms: controversial issues. Arch Pathol Lab Med. 2010;134:864–70.

    PubMed  Google Scholar 

  20. Misdraji J, Yantiss RK, Graeme-Cook FM, et al. Appendiceal mucinous neoplasms: a clinicopathologic analysis of 107 cases. Am J Surg Pathol. 2003;27:1089–103.

    Article  PubMed  Google Scholar 

  21. Pai RK, Beck AH, Norton JA, et al. Appendiceal mucinous neoplasms: clinicopathologic study of 116 cases with analysis of factors predicting recurrence. Am J Surg Pathol. 2009;33:1425–39.

    Article  PubMed  Google Scholar 

  22. Pai RK, Longacre TA. Appendiceal mucinous tumors and pseudomyxoma peritonei: histologic features, diagnostic problems, and proposed classification. Adv Anat Pathol. 2005;12:291–311.

    Article  PubMed  Google Scholar 

  23. Ronnett BM, Yan H, Kurman RJ, et al. Patients with pseudomyxoma peritonei associated with disseminated peritoneal adenomucinosis have a significantly more favorable prognosis than patients with peritoneal mucinous carcinomatosis. Cancer. 2001;92:85–91.

    Article  PubMed  CAS  Google Scholar 

  24. Ronnett BM, Zahn CM, Kurman RJ, et al. Disseminated peritoneal adenomucinosis and peritoneal mucinous carcinomatosis. A clinicopathologic analysis of 109 cases with emphasis on distinguishing pathologic features, site of origin, prognosis, and relationship to “pseudomyxoma peritonei”. Am J Surg Pathol. 1995;19:1390–408.

    Article  PubMed  CAS  Google Scholar 

  25. Yantiss RK, Shia J, Klimstra DS, et al. Prognostic significance of localized extra-appendiceal mucin deposition in appendiceal mucinous neoplasms. Am J Surg Pathol. 2009;33:248–55.

    Article  PubMed  Google Scholar 

  26. El Halabi H, Gushchin V, Francis J, et al. The role of cytoreductive surgery and heated intraperitoneal chemotherapy (CRS/HIPEC) in patients with high-grade appendiceal carcinoma and extensive peritoneal carcinomatosis. Ann Surg Oncol. 2012;19:110–4.

    Article  PubMed  Google Scholar 

  27. Deraco M, Gronchi A, Mazzaferro V, et al. Feasibility of peritonectomy associated with intraperitoneal hyperthermic perfusion in patients with Pseudomyxoma peritonei. Tumori. 2002;88:370–5.

    PubMed  Google Scholar 

  28. Swellengrebel HA, Zoetmulder FA, Smeenk RM, et al. Quantitative intra-operative assessment of peritoneal carcinomatosis - a comparison of three prognostic tools. Eur J Surg Oncol. 2009;35:1078–84.

    Article  PubMed  CAS  Google Scholar 

  29. Verwaal VJ, van Tinteren H, van Ruth S, et al. Predicting the survival of patients with peritoneal carcinomatosis of colorectal origin treated by aggressive cytoreduction and hyperthermic intraperitoneal chemotherapy. Br J Surg. 2004;91:739–46.

    Article  PubMed  CAS  Google Scholar 

  30. Bao P, Bartlett D. Surgical techniques in visceral resection and peritonectomy procedures. Cancer J. 2009;15:204–11.

    Article  PubMed  Google Scholar 

  31. 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;240:205–13.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Los G, Mutsaers PH, Lenglet WJ, et al. Platinum distribution in intraperitoneal tumors after intraperitoneal cisplatin treatment. Cancer Chemother Pharmacol. 1990;25:389–94.

    Article  PubMed  CAS  Google Scholar 

  33. Low RN, Barone RM. Combined diffusion-weighted and gadolinium-enhanced MRI can accurately predict the peritoneal cancer index preoperatively in patients being considered for cytoreductive surgical procedures. Ann Surg Oncol. 2012;19:1394–1401.

    Article  PubMed  Google Scholar 

  34. Lieu CH, Lambert LA, Wolff RA, et al. Systemic chemotherapy and surgical cytoreduction for poorly differentiated and signet ring cell adenocarcinomas of the appendix. Ann Oncol. 2012;23:652–8.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  35. Shapiro JF, Chase JL, Wolff RA, et al. Modern systemic chemotherapy in surgically unresectable neoplasms of appendiceal origin: a single-institution experience. Cancer. 2010;116:316–22.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Surgical Oncology, University of Texas Southwestern Medical Center, Dallas, USA

    Patricio M. Polanco MD

  2. Department of Biostatistics, University of Pittsburgh, Pittsburgh, USA

    Ying Ding PhD

  3. Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Jordan M. Knox BA, Lekshmi Ramalingam MD, Heather Jones MPA-C, Melissa E. Hogg MD, Amer H. Zureikat MD, Matthew P. Holtzman MD, James Pingpank MD, Steven Ahrendt MD, Herbert J. Zeh MD, David L. Bartlett MD & Haroon A. Choudry MD

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  1. Patricio M. Polanco MD
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  2. Ying Ding PhD
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  3. Jordan M. Knox BA
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  4. Lekshmi Ramalingam MD
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  13. Haroon A. Choudry MD
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Corresponding authors

Correspondence to David L. Bartlett MD or Haroon A. Choudry MD.

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Polanco, P.M., Ding, Y., Knox, J.M. et al. Outcomes of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemoperfusion in Patients with High-Grade, High-Volume Disseminated Mucinous Appendiceal Neoplasms. Ann Surg Oncol 23, 382–390 (2016). https://doi.org/10.1245/s10434-015-4838-z

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  • DOI: https://doi.org/10.1245/s10434-015-4838-z

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