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Secondary cytoreductive surgery for lymph node positive mucinous appendiceal neoplasms
Paul H Sugarbaker1, David Chang2
1Program in Peritoneal Surface Malignancy, Washington Cancer Institute, Washington, DC, USA.
Background:
Patients who have surgery for a gastrointestinal cancer routinely have clinical and radiological tests in an effort to detect recurrent disease. If cancer progression is documented, additional surgery performed in a timely manner may prolong survival and help maintain an optimal quality of life. In mucinous appendiceal cancer patients a secondary cytoreductive surgery (SCRS) may be considered if recurrent disease is detected.
Methods:
In patients with both lymph node metastases and peritoneal metastases from a mucinous appendiceal adenocarcinoma (MACA-LN) who had a prior complete cytoreductive surgery (CRS), the clinical- and treatment-related variables associated with the index CRS and the SCRS were extracted from a database and secured research files. These variables were statistically assessed for their impact on survival.
Results:
Twelve of 39 lymph node positive patients (30.8%) had SCRS. The mean follow-up was 7.6 years and the median survival was 4.5 years. There were 4 males (33%) and median age was 44 years. Significant prognostic variables associated with improved survival with the index CRS by univariant analysis was the use of early postoperative intraperitoneal chemotherapy (EPIC) (p = 0.0469). For the SCRS, no significant prognostic variables, not even completeness of cytoreduction, were discovered.
Conclusions:
In MACA-LN patients, improved survival with SCRS was shown as compared to patients who recurred but did not undergo SCRS. In this group of patients with an aggressive disease, if SCRS was possible it improved survival with long-term (greater than 5 years) follow-up.
