Journal
EJSO
Volume 47, Issue 6, Pages 1278-1285Publisher
ELSEVIER SCI LTD
DOI: 10.1016/j.ejso.2021.01.010
Keywords
HIPEC; EPIC; Cytoreductive surgery; Adenocarcinoid; Goblet cell carcinoid; Mixed adenocarcinoma carcinoid; Neoadjuvant chemotherapy; Peritoneal cancer index; Completeness of cytoreduction score; Abdominal-pelvic regions
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This study analyzed 47 patients with rare appendiceal malignancy at stage IV, showing that patients with less extensive disease and complete cytoreduction had improved prognosis, with no apparent benefit from systemic or perioperative regional chemotherapy.
Background: A rare appendiceal malignancy is characterized by both glandular and neuroendocrine histology. It often presents with dissemination of the perforated tumor to peritoneal surfaces. Current treatments involve systemic chemotherapy, cytoreductive surgery and perioperative intraperitoneal chemotherapy. Methods: The impact of clinical, histological and treatment-related characteristics on survival were evaluated and subjected to univariate statistical analyses. All patients had stage IV disease and were treated by a uniform treatment strategy. Survival was determined from onset of disease until death or most recent follow-up. Results: There were 47 patients available for study of whom 17 were male. Median age was 48 with a range of 27-65. None or a single symptom vs. 2 or more symptoms had a significant effect on survival. Median survival of the entire cohort was 45 months and 34.88% and 8.72% of patients survived 5 and 10 years, respectively. The use of neoadjuvant chemotherapy showed no impact on survival. Patients with a peritoneal cancer index (PCI) of 0-20 as compared to PCI > 20 survived longer (p = 0.012). The survival of patients able to have a complete resection as compared to an incomplete resection of disease was significant (p = 0.0087). The type of perioperative chemotherapy did not alter survival. Conclusions: These data show that patients with a lesser extent of disease with a complete cytoreduction had an improved prognosis. No benefit from systemic or perioperative regional chemotherapy was apparent. With long-term follow-up, patients with the combined glandular and neuroendocrine his-tology exhibiting peritoneal metastases have a guarded prognosis. (c) 2021 Elsevier Ltd, BASO -The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
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