scholarly journals Laparoscopic cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for perforated low-grade appendiceal mucinous neoplasms

2020 ◽  
Vol 34 (12) ◽  
pp. 5516-5521 ◽  
Author(s):  
Haytham Abudeeb ◽  
Chelliah R. Selvasekar ◽  
Sarah T. O’Dwyer ◽  
Bipasha Chakrabarty ◽  
Lee Malcolmson ◽  
...  
Keyword(s):  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Operative Time ◽  
Significant Proportion ◽  
Low Grade ◽  
Short Term ◽  
Open Operation ◽  
High Dependency ◽  
Mucinous Neoplasms

Abstract Introduction Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is an established treatment for pseudomyxoma peritonei (PMP) from perforated low-grade appendiceal mucinous neoplasms (LAMN II). In a selected group of LAMN II patients without established PMP, CRS/HIPEC can be performed laparoscopically (L-CRS/HIPEC); however the short-term benefits and safety of this approach have yet to be determined. This study aims to determine the short-term outcomes from a series of L-CRS/HIPEC LAMN II patients compared to those who have undergone a similar open operation (O-CRS/HIPEC) for low-volume PMP. Methods LAMN II patients undergoing L-CRS/HIPEC at a UK national peritoneal tumour centre were compared to O-CRS/HIPEC patients (peritoneal cancer index ≤ 7). Outcomes of interest included Clavien–Dindo complication grade, operative time, blood transfusions, high dependency unit (HDU) admission, length of hospital stay, and histopathological findings. Results 55 L-CRS/HIPEC were compared to 29 O-CRS/HIPEC patients (2003–2017). Groups were matched for age, sex, and procedures. Median operative time was 8.8 (IQR 8.1–9.5) h for L-CRS/HIPEC versus 7.3 (IQR 6.7–8) h for O-CRS/HIPEC (Mann–Whitney test p < 0.001). Post-operative HDU admission was 56% versus 97% (OR 0.04 95% CI 0.01–0.34) and median length of stay = 6 (IQR 5–8) versus 10 (IQR 8–11) days (p < 0.001) for L- versus O-CRS/HIPEC. Despite a normal pre-operative CT scan, 13/55 (23.6%) L-CRS/HIPEC patients had acellular mucin and 2/55 (3.5%) had mucin with epithelium present in their specimens. Residual appendix tumour was identified in 2/55 patients (3.6%). Clavien–Dindo Grade 1–4 complications were similar in both groups with no mortality. Conclusion L-CRS/HIPEC for LAMN II takes longer; however patients have significantly reduced length of HDU and overall stay, without increased post-operative complications. A significant proportion of LAMN II patients undergoing L-CRS/HIPEC have extra-appendiceal acellular mucin with some cases demonstrating residual cellular epithelium from the LAMN II. The risk of these patients developing PMP without surgery is under current review.

Utility of chemotherapy given before and/or after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for appendiceal adenocarcinoma with peritoneal metastases.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e16276-e16276
Author(s):  
Tyler Friedrich ◽  
Junxiao Hu ◽  
Robert William Lentz ◽  
Alexis Diane Leal ◽  
Sunnie S. Kim ◽  
...  
Keyword(s):  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Small Sample Size ◽  
Peritoneal Metastases ◽  
Small Sample ◽  
Histologic Grade ◽  
Low Grade ◽  
Appendiceal Adenocarcinoma

e16276 Background: Appendiceal adenocarcinoma is relatively rare and often diagnosed incidentally during operations for acute appendicitis. It is commonly associated, either at time of initial presentation or upon recurrence, with peritoneal metastases. A typical treatment strategy for patients with peritoneal disease includes cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC). Extrapolating largely from literature in colorectal cancer, chemotherapy is frequently given before and/or after CRS/HIPEC though high-level evidence to support this is lacking. We sought to evaluate the effect of systemic chemotherapy on survival. Methods: Utilizing a database of CRS/HIPEC procedures at University of Colorado Hospital from 2008 to present we retrospectively reviewed cases of appendiceal adenocarcinoma. Data collected included staging, histologic grade, chemotherapy given, surgical outcomes, and time to disease recurrence. Patients without adequate information regarding treatment, or without at least 1 year of clinical follow-up, were excluded. Associations between administration of chemotherapy or histologic grade and 1-year DFS were analyzed using Fisher’s exact test, and logistic regression was used to assess whether 1-year DFS were different in chemotherapy-treated patients when adjusted for histologic grade. Results: In total, 117 cases reviewed indicated an appendiceal pathology. Of these, 54 cases in a total of 51 patients met the specified criteria for pathology and completeness and length of follow-up information. The average age was 58 years (range 26-81 years). Adenocarcinoma was graded as low in 15 (28%) cases, intermediate in 18 (33%) cases, and high in 21 (39%) cases. 23 (43%) patients received no chemotherapy while 31 (57%) received chemotherapy before and/or after surgery. In the overall population, there was no significant effect of chemotherapy on survival, with 1-year DFS demonstrated in 74.2% of patients receiving some chemotherapy and 70% in patients not receiving chemotherapy (p = 0.765). One-year DFS was achieved in 86% of low-grade cases, 61% of intermediate-grade cases, and 71% of high-grade cases, though this was also not statistically significant (p = 0.254). Furthermore, when 1-year DFS between chemotherapy and non-chemotherapy patients was adjusted for grade, there was again no significant interaction (odds ratio = 0.48, 95% C.I. (0.13-1.64), p = 0.763). Conclusions: In this small, single-institution experience of patients with peritoneal appendiceal adenocarcinoma, there was no significant effect of chemotherapy administration on 1-year DFS. These findings are likely affected by significant confounding with the small sample size and retrospective nature of the data. Further investigation on a larger scale is warranted.

scholarly journals Short-Term Quality of Life Outcomes Following Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 232s-232s
Author(s):  
C. Koh ◽  
J. Young
Keyword(s):  
Quality Of Life ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Short Form ◽  
Staging System ◽  
Short Term ◽  
Extensive Disease ◽  
Crs And Hipec

Background: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is an established treatment of peritoneal malignancies (PM). However, it can also adversely affect patients' quality of life (QoL). Aim: This study reports short-term QoL outcomes following CRS and HIPEC and compares the QoL trajectories between patients with more extensive cancer to those with less extensive disease. Methods: Patients undergoing CRS and HIPEC at a single referral center between April 2017 and April 2018 were prospectively recruited. QoL was measured using short-form 36 version 2. Physical (PCS) and mental component scores (MCS) were scored according to the manual (higher scores reflect better QoL). Data were collected at baseline, predischarge, 3 and 6 months postoperatively. PCS and MCS trajectories were described. Results: Of 68 patients, 62 (91%) entered the study. Median PCS decreased from baseline to predischarge but this then recovers and improves beyond baseline by 3 months (43.4 IQR 35.2-55.2, 34.3 IQR 27.3-43.5, 48.1 IQR 37.6-52.5). Median MCS declined marginally postoperatively but improves above baseline by 3 months and continues to improve at 6 months (49.6 IQR 43.5-55.7, 47.8 IQR 39.9-55.0, 51.2 IQR 43.7-57.3, 56.2 IQR 42.8-58.6). Using a PCI (peritoneal carcinoma index, a staging system for the extent of disease from 0-39, higher value denotes more extensive disease) ≥ 15, patients with high PCI were found to have worse PCS at baseline (36.5 vs 48.9, P < 0.005). Despite nonstatistically significant differences in MCS between high PCI and low PCI patients, there is a clinically significant trend among patients with high PCI in that the trajectory for MCS is one of continued decline. Conclusion: Short-term QoL after CRS and HIPEC is acceptable. QoL returned to baseline quicker than anticipated. Further studies are needed to describe the long-term QoL and in particular, the relationship between PCI and QoL needs further evaluation.

scholarly journals Two-step cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for pseudomyxoma peritonei with high peritoneal carcinomatosis index

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Bertrand Trilling ◽  
Alexandre Brind’Amour ◽  
Raphael Hamad ◽  
Jean-Francois Tremblay ◽  
Pierre Dubé ◽  
...  
Keyword(s):  
Peritoneal Carcinomatosis ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Pseudomyxoma Peritonei ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Postoperative Morbidity ◽  
Low Grade ◽  
Peritoneal Carcinomatosis Index ◽  
Second Surgery ◽  
Very High

Abstract Background Complete cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is the only curative treatment for pseudomyxoma peritonei (PMP) arising from the appendix. High peritoneal carcinomatosis index (PCI) is associated with an increased risk of surgical complications. The objective of this study was to present the results of a planned two-step surgical strategy to decrease postoperative morbidity and improve resectability of patients with very high PCI. Methods All consecutive patients who underwent a planned two-step surgical approach for PMP between January 2012 and March 2020 were retrospectively included. This approach was offered for patients with low-grade PMP with PCI > 28 for which feasibility of a complete CRS in one operation was uncertain. The first surgery included a complete CRS of the inframesocolic compartment and omentectomy. HIPEC was delivered at the second surgery, after complete CRS of the supramesocolic compartment. Postoperative morbidity was assessed using the Clavien-Dindo classification and survival results were also collected. Results Eight patients underwent the two-step approach. The median PCI was 33 (29–39) and the median time between the two procedures was 111 days (90–212 days). One patient was deemed unresectable at the second surgery. The rate of major morbidity was 0% for the first step and 25% for the second step, with no mortality. Median follow-up was 53.8 months (3–73 months). Conclusion A two-step surgical management for low-grade PMP patients with very high PCI is safe and feasible, with acceptable postoperative morbidity and no compromise on oncological outcomes.

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