Repeat Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy for Recurrent Mucinous Appendiceal Adenocarcinoma: A Viable Treatment Strategy with Demonstrable Benefit

Authors

Neal Bhutiani
Travis E Grotz
Seth J Concors
Michael G White
Beth A Helmink
Kanwal P Raghav
Melissa W Taggart
Karen A Beaty
Richard E Royal
Michael J Overman
Aurelio Matamoros
Christopher P Scally
Safia Rafeeq
Paul F Mansfield
Keith F Fournier

Publication Date

1-1-2024

Journal

Annals of Surgical Oncology

Abstract

INTRODUCTION: Many patients with mucinous appendiceal adenocarcinoma experience peritoneal recurrence despite complete cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Prior work has demonstrated that repeat CRS/HIPEC can prolong survival in select patients. We sought to validate these findings using outcomes from a high-volume center.

PATIENTS AND METHODS: Patients with mucinous appendiceal adenocarcinoma who underwent CRS/HIPEC at MD Anderson Cancer Center between 2004 and 2021 were stratified by whether they underwent CRS/HIPEC for recurrent disease or as part of initial treatment. Only patients who underwent complete CRS/HIPEC were included. Initial and recurrent groups were compared.

RESULTS: Of 437 CRS/HIPECs performed for mucinous appendiceal adenocarcinoma, 50 (11.4%) were for recurrent disease. Patients who underwent CRS/HIPEC for recurrent disease were more often treated with an oxaliplatin or cisplatin perfusion (35%/44% recurrent vs. 4%/1% initial, p < 0.001), had a longer operative time (median 629 min recurrent vs. 511 min initial, p = 0.002), and had a lower median length of stay (10 days repeat vs. 13 days initial, p < 0.001). Thirty-day complication and 90-day mortality rates did not differ between groups. Both cohorts enjoyed comparable recurrence free survival (p = 0.82). Compared with patients with recurrence treated with systemic chemotherapy alone, this select cohort of patients undergoing repeat CRS/HIPEC enjoyed better overall survival (p < 0.001).

CONCLUSIONS: In appropriately selected patients with recurrent appendiceal mucinous adenocarcinoma, CRS/HIPEC can provide survival benefit equivalent to primary CRS/HIPEC and that may be superior to that conferred by systemic therapy alone in select patients. These patients should receive care at a high-volume center in the context of a multidisciplinary team.

Keywords

Humans, Hyperthermic Intraperitoneal Chemotherapy, Cytoreduction Surgical Procedures, Combined Modality Therapy, Antineoplastic Combined Chemotherapy Protocols, Hyperthermia, Induced, Peritoneal Neoplasms, Neoplasm Recurrence, Local, Appendiceal Neoplasms, Adenocarcinoma, Mucinous, Retrospective Studies, Survival Rate

Comments

Supplementary Materials

PMID: 37872456