Third look surgery and beyond for appendiceal malignancy with peritoneal dissemination

Area of Science:

• Surgical oncology
• Gastrointestinal oncology

Background:

• Recurrent peritoneal dissemination from appendiceal malignancy presents challenges for repeat surgical interventions.
• Established criteria for third, fourth, and subsequent reoperations are lacking.

Purpose of the Study:

• To evaluate survival outcomes and identify predictors of success in patients undergoing multiple reoperations for appendiceal malignancy.
• To establish selection criteria for subsequent reoperative surgeries.

Main Methods:

• Analysis of a prospective database of 501 patients with appendiceal epithelial peritoneal surface malignancy treated with cytoreductive surgery and intraperitoneal chemotherapy.
• Focus on 45 patients (8.9%) who underwent three or more operative interventions.
• Statistical analysis of clinical features and survival rates.

Main Results:

• Overall 5-year survival for patients with 3+ reoperations was 70%.
• Survival rates increased with the number of interventions up to five or more (100% 5-year survival).
• Complete cytoreduction for second and third interventions correlated with improved 5-year survival; tumor biology became more influential after four interventions.

Conclusions:

• Complete cytoreduction is a significant factor for prolonged survival in patients with recurrent appendiceal malignancy undergoing multiple reoperations.
• After four or more interventions, tumor biology appears to be the predominant factor influencing outcomes.
• While multiple reoperations can lead to prolonged survival, cancer cure is infrequent.