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Outcomes of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy in 92 Patients with Peritoneal
Vladimir Milovanov1, Brendan Moran2, Faheez Mohamed2
1Clinical Fellow in Peritoneal Surface Malignancy, Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Basingstoke, Hampshire, UK. vladimirmilovanov@gmail.com.
Background:
Goblet cell adenocarcinoma (GCA) of the appendix with peritoneal metastases poses treatment challenges. Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) offers a potentially curative approach. This study evaluates outcomes in patients with appendiceal GCA undergoing CRS/HIPEC.
Methods:
We retrospectively analyzed 92 patients with GCA and peritoneal metastases treated by CRS/HIPEC. Tumour markers were assessed preoperatively. All underwent midline laparotomy and peritoneal cancer index (PCI) calculation. Mitomycin C (10 mg/m2) HIPEC was perfused for 60 min at 42-43 °C. Immediate and long-term outcomes were analyzed.
Results:
Mean age was 58 years; 35% male. Tumours were classified by Tang criteria: Tang A (2), Tang B (39), Tang C (40), and 11 unclassified. Mean operative time was 7 hours; mean PCI was 18. Complete cytoreduction (CC 0-1) was achieved in 67%. No perioperative mortality occurred. Postoperative complications occurred in 64%, with 6% grade 3/4. Median follow-up was 88 months. PCI < 20 had median overall survival (OS) of 34 months versus 11 months for PCI > 20 (p < 0.0001). Median OS was 30 months in CC 0-1 versus 11 months in CC 2-3 (p = 0.0004). Median progression-free survival in CC 0-1 was 13 months. Positive lymph nodes were found in 67%, with no significant OS difference. Elevated CA125 (> 3× normal) predicted poorer prognosis (median OS 9 vs. 29 months; p = 0.0116). Overall median OS was 23 months; 5-year survival was 14%.
Conclusion:
CRS and HIPEC provide 14% 5-year survival for GCA with peritoneal metastases. Complete cytoreduction, especially with PCI < 20, improves outcomes.
