Treatment failure following complete cytoreductive surgery and perioperative intraperitoneal chemotherapy for peritoneal dissemination from colorectal or appendiceal mucinous neoplasms

Background: Peritonectomy combined with perioperative intraperitoneal chemotherapy is a successful treatment option for patients with peritoneal dissemination of appendiceal and colorectal malignancy. Despite its efficacy, recurrences remain a common problem. Methods: Patients with peritoneal dissemination from appendiceal or colorectal malignancy who underwent complete cytoreduction and perioperative intraperitoneal chemotherapy were included in this study. Data regarding recurrent disease found on abdominal exploration and/or diagnostic studies was extracted from a prospective database and analyzed. Results: Seventy patients with colorectal cancer carcinomatosis and 402 with appendiceal neoplasm were analyzed. Forty-nine of 70 and 111 of 402 patients developed documented recurrences. The median survival of 49 patients with colorectal cancer was 33 months while the median survival for patients with appendiceal neoplasms was not reached. The most common type of recurrent disease was it localized intra-abdominal recurrence for both appendiceal and colon cancer patients. Patients who underwent second surgery for recurrent disease had an improved survival. Conclusion: Additional treatments should be strongly considered in patients who fail an initial cytoreduction combined with perioperative intraperitoneal chemotherapy. This resulted in 5-year survival in 17% of colorectal patients and 70% of the appendiceal mucinous neoplasm patients.