Complete Cytoreduction Offers Longterm Survival in Patients with Peritoneal Carcinomatosis from Appendiceal Tumors of Unfavorable Histology

BACKGROUND: Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is a rapidly evolving treatment for metastatic appendiceal neoplasms. The aim of this study was to show the effect of complete cytoreduction. (CC) on survival in patients undergoing CRS and HIPEC for high-grade appendiceal neoplasm. STUDY DESIGN: A retrospective study of a prospective database of 56 patients (from 1999 to 2007) with appendiceal neoplasms treated with CRS and HIPEC was carried out. Histology of the disease, CC score, and peritoneal cancer index (PCI) score were assessed independently and collectively for each group of patients. Survival analysis was performed using the Cox proportional hazard model. RESULTS: Three-year overall survival was 60%. The median peritoneal cancer index score was 25 or higher. Survival analysis by tumor histology was 80% for patients with low-grade tumors and 52% for patients with high-grade tumors (p = 0.024). Survival by completeness of cytoreduction was 78% for patients with a low CC score (0 to 1) and 28% in patients with a high CC score (2 to 3; p = 0.01). There was no statistically significant difference in survival between the low-grade and high-grade tumors when a complete cytoreduction was performed in both groups of patients: 80% versus 68% (p = 0.69). CONCLUSIONS: CRS and HIPEC is ail effective treatment for patients with disseminated appendiceal tumors. High-grade tumors also benefit from this approach and should not be excluded from CRS and HIPEC. Every effort should be made to achieve a complete cytoreduction regardless of the tumor histology. (J Am Coll Surg 2009;209:308-312. (C) 2009 by the American College of Surgeons)