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Appendiceal pseudomyxoma peritonei: predictors of recurrence and iterative surgery

Joseph C Kong1,2,3, Michael P Flood1,2,3, Glen R Guerra1,2,3,4

  • 1Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.

Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland
|June 22, 2021
PubMed
Abstract

Insights

Recurrent appendiceal pseudomyxoma peritonei (PMP) can be treated with repeat cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), offering good outcomes in selected patients. Age and tumor grade predict eligibility for this iterative surgery.

Area of Science:

  • Oncology
  • Surgical Oncology
  • Gastroenterology

Background:

  • Appendiceal pseudomyxoma peritonei (PMP) has a significant recurrence rate (26%) even after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).
  • Limited data exists on recurrence patterns and predictors for PMP specifically arising from non-infiltrative appendiceal mucinous neoplasms (LAMN and HAMN).

Purpose of the Study:

  • To identify recurrence patterns in patients with PMP originating from LAMN or HAMN.
  • To determine predictive factors for selecting patients suitable for iterative CRS and HIPEC.

Main Methods:

  • A bi-institutional retrospective analysis of patients with PMP from perforated LAMN or HAMN who underwent complete CRS and HIPEC.
  • Multivariate logistic and Cox regression analyses were used to identify predictors for re-do CRS, overall survival (OS), and disease-free survival (DFS).

Main Results:

  • Peritoneal recurrence occurred in 25.1% of patients, with a median time to recurrence of 20.7 months.
  • High-grade PMP and higher Peritoneal Cancer Index (PCI) were associated with increased recurrence risk.
  • Patients over 60 years old and with high-grade index histology were less likely to be offered iterative surgery.
  • Iterative CRS and HIPEC resulted in 100% 5-year survival.

Conclusions:

  • Iterative CRS and HIPEC is a viable treatment for selected recurrent PMP patients, yielding favorable oncological outcomes.
  • Patient age, initial tumor histology, and the extent of abdominal involvement predict suitability for repeat surgery.
Keywords:
HIPECPseudomyxoma peritoneicytoreductive surgeryrecurrencesurvival

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