Extensive cytoreductive surgery for appendiceal carcinomatosis: morbidity, mortality, and survival. Ann Surg Oncol 2013 Apr;20(4):1056-62
Date
03/05/2013Pubmed ID
23456385Pubmed Central ID
PMC4100554DOI
10.1245/s10434-012-2791-7Scopus ID
2-s2.0-84875231943 (requires institutional sign-in at Scopus site) 33 CitationsAbstract
BACKGROUND: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemoperfusion (HIPEC) are frequently used to treat appendiceal carcinomatosis. Some patients require multivisceral resection because of the volume of disease. It is unclear whether extent of CRS impacts survival in appendiceal carcinomatosis.
METHODS: We analyzed 282 patients undergoing attempted CRS/HIPEC for appendiceal carcinomatosis. Patients were defined as having undergone Extensive CRS (n = 60) if they had >3 organ resections or >2 anastomoses; a subgroup of Extreme CRS patients (n = 10) had ≥5 organ resections and ≥3 anastomoses. Kaplan-Meier survival curves and multivariate Cox-regression models were used to identify prognostic factors affecting outcomes.
RESULTS: Relative to the comparison group, patients undergoing Extensive CRS had a higher median peritoneal carcinomatosis index, operative duration, blood loss, and length of stay. No difference in completeness of cytoreduction, severe morbidity, or 60-day mortality was evident. Subgroup analysis of 10 patients undergoing extreme CRS likewise revealed no increase in severe morbidity or mortality. Median progression-free (PFS) and overall survival (OS) were 23.5 and 74 months in the comparison group; 18.5 (p = 0.086) and 51 (p = 0.85) months in the Extensive CRS group; and 40 months and not reached in the Extreme CRS subgroup. In a multivariable analysis, extent of CRS was not independently associated with PFS or OS.
CONCLUSIONS: Extensive CRS is associated with greater OR time, blood loss, and length of stay, but is not associated with higher morbidity, mortality, or inferior oncologic outcomes in patients with appendiceal carcinomatosis.
Author List
Wagner PL, Austin F, Maduekwe U, Mavanur A, Ramalingam L, Jones HL, Holtzman MP, Ahrendt SA, Zureikat AH, Pingpank JF, Zeh HJ, Bartlett DL, Choudry HAAuthor
Ugwuji N. Maduekwe MD Associate Dean, Associate Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Antineoplastic Combined Chemotherapy ProtocolsAppendectomy
Appendiceal Neoplasms
Carcinoma, Signet Ring Cell
Chemotherapy, Adjuvant
Chemotherapy, Cancer, Regional Perfusion
Combined Modality Therapy
Female
Follow-Up Studies
Humans
Hyperthermia, Induced
Male
Middle Aged
Morbidity
Neoplasm Grading
Neoplasm Recurrence, Local
Peritoneal Neoplasms
Prognosis
Prospective Studies
Survival Rate
