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Cytoreductive Surgery With or Without Intraperitoneal Chemotherapy for Peritoneal Spread from Appendiceal Neoplasms
Jung Wook Suh1, Hwan Namgung2, Jae Won Jo1
1Department of Surgery, Dankook University Hospital, Cheonan-si, Republic of Korea.
Background/Aim:
Cytoreductive surgery (CRS) and intraperitoneal chemotherapy are standard treatments for the peritoneal spreading from appendiceal tumours. We aimed to assess and compare outcomes after CRS, with or without intraperitoneal chemotherapy, in patients with peritoneal spreading from appendiceal neoplasms and malignancies.
Patients And Methods:
In this retrospective study, we analysed prospectively collected data from patients with appendiceal tumours and peritoneal metastases who were treated with CRS and intraperitoneal chemotherapy. Survival analysis was performed to evaluate overall survival, completeness of cytoreduction (CCR) 0-1, subgroup outcomes, and survival-influencing factors.
Results:
We analysed data on 47 patients, including 10 (21.3%) with appendiceal neoplasms and 37 (78.7%) with appendiceal cancer. By the last follow-up visit, 23 patients had survived. The 5-year survival rate was significantly higher in the appendiceal neoplasm group (50%) than in the appendiceal cancer group (21.6%). Patients with CCR grades 2-3 had a 6.7-fold higher risk of mortality than those with CCR grades 1-2. Additionally, appendiceal cancer was associated with an 8-fold higher risk of mortality than low-grade appendiceal neoplasms. Postoperative chemotherapy was associated with 74.6% risk reduction, highlighting its potential benefits.
Conclusion:
Peritoneal metastases from appendiceal tumours, particularly pseudomyxoma peritonei arising from low-grade appendiceal mucinous neoplasms, show acceptable oncologic outcomes with aggressive treatment approaches, such as CRS combined with intraperitoneal chemotherapy. Therefore, CRS should be performed in cases where complete cytoreduction is achievable.
