Ki67 Does Not Predict Recurrence for Low Grade Appendiceal Mucinous Neoplasms with Peritoneal Dissemination after Cytoreductive Surgery and HIPEC

2021 ◽  
Author(s):  
Erin P. Ward ◽  
Luke Okamuro ◽  
Sohini Khan ◽  
Morgan Hosseini ◽  
Mark A. Valasek ◽  
...  
Keyword(s):  
Cytoreductive Surgery ◽  
Peritoneal Dissemination ◽  
Low Grade ◽  
Mucinous Neoplasms

scholarly journals Altered linkage pattern of N-glycan sialic acids in pseudomyxoma peritonei

Glycobiology ◽  
2020 ◽  
Author(s):  
Pirjo Nummela ◽  
Annamari Heiskanen ◽  
Soili Kytölä ◽  
Caj Haglund ◽  
Anna Lepistö ◽  
...  
Keyword(s):  
Pseudomyxoma Peritonei ◽  
Peritoneal Dissemination ◽  
Sialic Acids ◽  
Low Grade ◽  
High Grade ◽  
Malignant Diseases ◽  
Linkage Pattern ◽  
Mucinous Neoplasms ◽  
Sialic Acid Binding ◽  
Tissue Specimens

Abstract Pseudomyxoma peritonei (PMP) is a highly mucinous adenocarcinoma growing in the peritoneal cavity and most commonly originating from the appendix. Glycans play an important role in carcinogenesis, and glycosylation is altered in malignant diseases, including PMP. We have previously demonstrated that fucosylation of N-glycans is increased in PMP, but we did not observe modulation of overall sialylation. As sialic acids can be attached to the rest of the glycan via α2,3- or α2,6-linkage, we have now analyzed the linkage patterns of sialic acids in tissue specimens of normal appendices, low-grade appendiceal mucinous neoplasms (LAMN), low-grade (LG) PMP and high-grade (HG) PMP. For the linkage analysis, the enzymatically released acidic N-glycans were first treated with ethyl esterification or α2,3-sialidase digestion followed by MALDI-TOF mass spectrometry. Significant increase in the relative abundance of α2,6-sialylated and decrease in α2,3-sialylated N-glycans was observed in PMP tumors as compared to the normal appendices (P < 0.025). More specifically, increased α2,6-sialylation (P < 0.05) and decreased α2,3-sialylation (P < 0.01) were detected in afucosylated and monofucosylated N-glycans of PMPs, whereas the less abundant multifucosylated glycans, containing terminal fucose, demonstrated increased α2,3-sialylation (P < 0.01). Importantly, the increase in α2,6-sialylation was also detected between PMP and the appendiceal precursor lesion LAMN (P < 0.01). The identified glycosylation alterations produce ligands for sialic acid-binding immunoglobulin-like lectins (Siglecs) and sialofucosylated glycans binding selectins, which play a role in the peritoneal dissemination and progression of the disease.

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.

Appendiceal Cancer and Peritoneal Carcinomatosis: A Report of 29 Cases

2006 ◽  
Vol 72 (8) ◽  
pp. 714-718
Author(s):  
Jesus Esquivel ◽  
Barry Merriman ◽  
Sallie Davis ◽  
Darrell Manning
Keyword(s):  
Median Survival ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Peritoneal Dissemination ◽  
Hazard Ratio ◽  
Low Grade ◽  
Peritoneal Surface Malignancies ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Peritoneal surface malignancies of appendiceal origin arise from a perforated neoplasm with gradual expansion of the tumor within the abdomen. We report our experience with 29 patients. Between February 2000 and November 2004, 29 patients were classified into one of three groups based on the features of their peritoneal dissemination. Group 1 included those with extracellular mucin with little cellular atypia (disseminated peritoneal adenomucinosis/low-grade mucinous adenocarcinomas). Group 2 included those with peritoneal mucinous carcinomatosis/high-grade mucinous adenocarcinomas, and Group 3 included those with nonmucinous carcinomatosis. There were 17 patients in Group 1, 9 in Group 2, and 3 in Group 3. The majority had cytoreductive surgery and intraperitoneal chemotherapy. There were no operative deaths. Mean follow-up was 21 months. Median survival for Groups 1 and 2 has not been reached. Group 3 patients were more likely to die than Group 1 patients, with a hazard ratio of 48.0 ( P = 0.001), and Group 2 patients with a hazard ratio of 7.8 ( P = 0.029). Median survival for Group 3 was 5 months. These data add to the growing evidence that supports cytoreductive surgery and intraperitoneal chemotherapy in a selected group of patients. Those with mucinous peritoneal dissemination are more likely to benefit from this approach. It appears that in patients with nonmucinous carcinomatosis, the biology of the tumor predicts their outcome.

Classification of and cytoreductive surgery for low-grade appendiceal mucinous neoplasms

2012 ◽  
Vol 99 (7) ◽  
pp. 987-992 ◽  
Author(s):  
J. R. McDonald ◽  
S. T. O'Dwyer ◽  
S. Rout ◽  
B. Chakrabarty ◽  
K. Sikand ◽  
...  
Keyword(s):  
Cytoreductive Surgery ◽  
Low Grade ◽  
Mucinous Neoplasms

Necessity of posttreatment surveillance for low‐grade appendiceal mucinous neoplasms

2021 ◽  
Author(s):  
Aakash R. Gupta ◽  
Brian C. Brajcich ◽  
Anthony D. Yang ◽  
David J. Bentrem ◽  
Ryan P. Merkow
Keyword(s):  
Low Grade ◽  
Mucinous Neoplasms
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