Treatment and Management of Peritoneal Spread from Appendiceal Neoplasms

Appendiceal neoplasms are rare entities prone to direct peritoneal spread. As these neoplasms occur in few patients, research regarding their management is largely retrospective, limiting its utility. Classification of these neoplasms continues to evolve and is largely based on histopathology. Thorough workup of patients with appendiceal mucinous neoplasms is essential for appropriate management and decision making. The cornerstone of treatment of low-grade and high-grade appendiceal mucinous neoplasms with peritoneal spread is cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC), with limited use of systemic chemotherapy. For those patients who experience recurrence, it may be managed using CRS/HIPEC and possibly systemic chemotherapy.