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Survival benefits with EPIC in addition to HIPEC for low grade appendiceal neoplasms with pseudomyxoma peritonei: a
Raymond Hayler1,2,3, Kathleen Lockhart1, Shoma Barat1,2
1Peritonectomy and Liver Cancer Unit, Department of Surgery, St George Hospital, NSW, Sydney, Australia.
Objectives:
Appendiceal cancer is a rare malignancy, occurring in roughly 1.2 per 100,000 per year. Low grade appendiceal neoplasams (LAMN) in particular can lead to pseudomyxoma peritonei (PMP), and respond poorly to systemic chemotherapy. Standard treatment includes cytoreduction surgery (CRS) with addition of heated intraoperative peritoneal chemotherapy (HIPEC). Several centres include early postoperative intraperitoneal chemotherapy (EPIC) however; the literature is mixed on the benefits. We aim to examine the benefits of additional EPIC through a propensity-matched analysis.
Methods:
Patients with LAMN with PMP who underwent cytoreductive surgery at St George hospital between 1996 and 2020 were included in this retrospective analysis. Propensity score matching was performed with the following used to identify matched controls; sex, age, American Society of Anesthesiologists (ASA) grade, peritoneal cancer index (PCI) and morbidity grade. Outcomes measured included length of stay and survival.
Results:
A total of 224 patients were identified of which 52 received HIPEC alone. Propensity matching was performed to identify 52 matched patients who received HIPEC + EPIC. Those receiving HIPEC + EPIC were younger at 54.3 vs. 58.4 years (p=0.044). There was a median survival benefit of 34.3 months for HIPEC + EPIC (127.3 vs. 93.0 months, p=0.02). Median length of stay was higher in those who received EPIC (25.0 vs. 23.5 days, p=0.028).
Conclusions:
In LAMN with PMP, the addition of EPIC to HIPEC with CRS improves overall survival in propensity score matched cases but results in prolonged hospitalisation. The use of EPIC should still be considered in selected patients.
Insights
Adding early postoperative intraperitoneal chemotherapy (EPIC) to heated intraoperative peritoneal chemotherapy (HIPEC) with cytoreductive surgery (CRS) improves survival for low-grade appendiceal neoplasm with pseudomyxoma peritonei (LAMN with PMP). However, EPIC also increases hospital stay.
Area of Science:
- Oncology
- Surgical Oncology
- Gastroenterology
Background:
- Appendiceal cancer is rare, with low-grade appendiceal neoplasm (LAMN) potentially leading to pseudomyxoma peritonei (PMP).
- LAMN with PMP is often resistant to chemotherapy.
- Standard treatment involves cytoreductive surgery (CRS) and heated intraoperative peritoneal chemotherapy (HIPEC).
Purpose of the Study:
- To evaluate the survival benefits of adding early postoperative intraperitoneal chemotherapy (EPIC) to HIPEC with CRS for LAMN with PMP.
- To analyze outcomes using a propensity-matched approach.
Main Methods:
- Retrospective analysis of 224 patients with LAMN with PMP undergoing CRS between 1996 and 2020.
- Propensity score matching based on sex, age, ASA grade, PCI, and morbidity.
- Comparison of outcomes between HIPEC alone and HIPEC + EPIC groups.
Main Results:
- 52 patients received HIPEC alone, matched with 52 patients who received HIPEC + EPIC.
- The HIPEC + EPIC group was younger (54.3 vs. 58.4 years, p=0.044).
- HIPEC + EPIC showed a median survival benefit of 34.3 months (127.3 vs. 93.0 months, p=0.02) but a longer hospital stay (25.0 vs. 23.5 days, p=0.028).
Conclusions:
- Addition of EPIC to HIPEC with CRS improves overall survival in propensity score-matched LAMN with PMP cases.
- EPIC is associated with prolonged hospitalization.
- Consideration of EPIC in selected LAMN with PMP patients is warranted.
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