Incomplete cytoreduction in 174 patients with peritoneal carcinomatosis from appendiceal malignancy

Abstract

Objective: The aim of this study was to analyze the survival of patients with peritoneal dissemination of appendiceal malignancy having incomplete cytoreductive surgery.

Summary background data: Cytoreductive surgery plus perioperative intraperitoneal chemotherapy has emerged as a new and potentially curative treatment option for patients with peritoneal dissemination of appendiceal mucinous tumors. The goal of surgery is to remove all visible disease. Nevertheless, in some patients, complete cytoreduction is not possible.

Methods: Over a 30-year period, 645 patients with epithelial peritoneal surface malignancy of appendiceal origin were treated with cytoreductive surgery and intraperitoneal chemotherapy by a single surgeon. One hundred seventy-four (27.1%) of these patients had an incomplete cytoreduction. A critical statistical analysis of the impact of selected clinical features on survival was performed from a prospective database.

Results: Mortality and morbidity rates were 0% and 33.3%, respectively. Median survival of these 174 patients was 20.5 months and their 1-year, 3-year, and 5-year survival rates were 71%, 34%, and 15%, respectively. By multivariate analysis, the presence of signet ring cells and lymph node involvement were independent prognostic indicators of poor survival (P = 0.047 and P < 0.001, respectively). Patients who underwent more than 1 cytoreduction or repeat intraperitoneal chemohyperthermia showed significant improvement in survival (P = 0.018 and P < 0.001, respectively)

Conclusion: Incomplete cytoreduction plus perioperative intraperitoneal chemotherapy of peritoneal dissemination from appendiceal malignancy results in limited long-term survival. Patients with signet ring histology or lymph node involvement have an especially poor outcome. Repeat cytoreduction and intraperitoneal chemohyperthermia may improve outcome.

Figures

FIGURE 1. Kaplan-Meier survival distribution for 174 patients treated by incomplete cytoreductive surgery. Survival was computed from the initial cytoreduction performed at our institution.

FIGURE 2. Kaplan-Meier survival distribution for 137 patients treated by incomplete cytoreductive surgery according to the type of perioperative intraperitoneal chemotherapy. Survival was computed from the initial cytoreduction performed at our institution. IPCH, intraperitoneal chemohyperthermia; EPIC, early postoperative intraperitoneal chemotherapy.

FIGURE 3. Kaplan-Meier survival distribution based on number of operative interventions. Survival was computed from the initial cytoreduction performed at our institution.

FIGURE 4. Kaplan-Meier survival distribution based on the morphologic type of the tumor. Survival was computed from the initial cytoreduction performed at our institution.

FIGURE 5. Kaplan-Meier survival distribution based on the presence of signet ring cells. Survival was computed from the initial cytoreduction performed at our institution.

FIGURE 6. Kaplan-Meier survival distribution based on the presence of lymph node involvement. Survival was computed from the initial cytoreduction performed at our institution.