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Appendiceal Adenocarcinoma Discovered During Acute Perforated Appendicitis: A Potential Contribution of Prophylactic
Elsa Leiritz1, Jade Fawaz2,3, Isabelle Sourrouille4
1Department of Digestive, Hepatobiliary Surgery and Liver Transplantation, Hôpital de la Pitié Salpétrière, Assistance Publique-Hôpitaux de Paris and Sorbonne Université, Paris, France.
Background:
Treatment of peritoneal metastasis (PM) from appendicular adenocarcinoma consists of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). No specific recommendation exists in case of acute appendicular syndrome (AAS) with perforated tumor.
Patients And Methods:
Data from 12 expert centers from the BIG-RENAPE network were collected. We analyzed 5-year overall survival (OS), 5-year disease-free survival (DFS), and 5-year peritoneal-free survival (PFS) between carcinologic right colectomy (CRC) and prophylactic CRS with HIPEC (pCRS + HIPEC) groups. Survival analysis was also performed between CRC, pCRS + HIPEC, and curative CRS with HIPEC (cCRS + HIPEC) groups.
Results:
Carcinologic surgery was performed in 130 patients: 11 in CRC, 44 in pCRS + HIPEC, and 75 in cCRS + HIPEC groups. OS was 96.9% (95% confidence interval [CI]: 91.0-100%) in the pCRS + HIPEC group compared with 51.9% (95% CI 21.6-100%) in the CRC group (p < 0.001). The 5-year DFS was 75.2% (95% CI 60.5-93.5%) in the pCRS + HIPEC group compared with 34.3% (95% CI 11.2-100 %) in the CRC group (p = 0.003). The 5-year PFS was 77.6% (95% CI 63.0-95.6%) in the pCRS + HIPEC group compared with the CRC group 34.3% (95% CI 11.2-100 %) (p = 0.001). When comparing all three groups, OS and DFS were significantly better in the pCRS + HIPEC group compared with the CRC and cCRS + HIPEC groups. There were no significant differences in postoperative morbidity between the three groups.
Conclusions:
Performing pCRS + HIPEC in the case of perforated appendiceal adenocarcinoma discovered during AAS seems to be associated with better OS compared with performing CRC. This therapeutic option should systematically be discussed in cases of perforated appendiceal adenocarcinoma discovered during acute appendicitis.
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