Early postoperative intraperitoneal chemotherapy is associated with survival benefit for appendiceal adenocarcinoma with peritoneal dissemination

Yeqian Huang; Nayef A Alzahrani; Winston Liauw; Hussein Soudy; Abdulaziz M Alzahrani; David L Morris

doi:10.1016/j.ejso.2017.09.002

Early postoperative intraperitoneal chemotherapy is associated with survival benefit for appendiceal adenocarcinoma with peritoneal dissemination

Eur J Surg Oncol. 2017 Dec;43(12):2292-2298. doi: 10.1016/j.ejso.2017.09.002. Epub 2017 Sep 28.

Authors

Yeqian Huang¹, Nayef A Alzahrani², Winston Liauw³, Hussein Soudy⁴, Abdulaziz M Alzahrani¹, David L Morris⁵

Affiliations

¹ Department of Surgery, University of New South Wales, St George Hospital, New South Wales, Australia.
² Department of Surgery, University of New South Wales, St George Hospital, New South Wales, Australia; College of Medicine, Imam Muhammad Ibn Saud Islamic University, Riyadh, Saudi Arabia.
³ Department of Medical Oncology, University of New South Wales, St George Hospital, Sydney, New South Wales, Australia.
⁴ Department of Surgery, University of New South Wales, St George Hospital, New South Wales, Australia; Faculty of Medicine, Cairo University, Giza, Egypt.
⁵ Department of Surgery, University of New South Wales, St George Hospital, New South Wales, Australia. Electronic address: david.morris@unsw.edu.au.

PMID: 29017824
DOI: 10.1016/j.ejso.2017.09.002

Abstract

Introduction: The combined approach of cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) has achieved encouraging outcomes for patients with PMCA with peritoneal dissemination. However, there is little evidence for the use of EPIC in addition to HIPEC in this group of patients.

Patients and methods: This was a retrospective study of prospectively collected data of consecutive patients with PMCA who underwent CRS and perioperative intraperitoneal chemotherapy by one surgical team at St George Hospital in Sydney, Australia between Jan 1996 and Aug 2016.

Results: A total of 185 patients formed the cohort of this study. However, there was no significant difference in terms of hospital mortality (p = 0.632), major morbidity rate (i.e. Grade III/IV) (p = 0.444), intensive unit care stay (p = 0.638) and total hospital stay (p = 0.0.078). However, patients who received HIPEC and EPIC had a significant longer stay in high dependency unit (p < 0.001). Multivariate analysis showed combined HIPEC with EPIC is an independent prognostic factor for better overall survival (Hazard ratio (HR) = 0.42, 95% confidence interval (CI) = 0.19-0.92, P = 0.030) and disease free survival (HR = 0.66, 95%CI = 0.44-0.99, p = 0.045), adjusted for age, sex, peritoneal cancer index, completeness of cytoreduction score, CEA ≥ 6.5 mg/L, CA19-9 ≥ 24.0 U/mL and CA125 ≥ 32.0 U/mL.

Conclusions: In summary, the combination of HIPEC and EPIC could potentially provide additional survival benefit for patients with PMCA with peritoneal spread as compared to HIPEC alone without increasing postoperative morbidity and mortality. More studies are warranted to further confirm the potential benefits of EPIC in PMCA and address the question of optimal drug and/or duration of EPIC.

Keywords: Appendiceal adenocarcinoma; Cytoreductive surgery; Early postoperative intraperitoneal chemotherapy; Pseudomyxoma peritonei.

MeSH terms

Adenocarcinoma / drug therapy*
Adenocarcinoma / mortality
Adenocarcinoma / surgery
Appendiceal Neoplasms / drug therapy*
Appendiceal Neoplasms / mortality
Appendiceal Neoplasms / surgery
Chemotherapy, Adjuvant
Chemotherapy, Cancer, Regional Perfusion
Combined Modality Therapy
Cytoreduction Surgical Procedures
Female
Humans
Hyperthermia, Induced
Male
Middle Aged
Peritoneal Neoplasms / drug therapy*
Peritoneal Neoplasms / mortality
Retrospective Studies
Survival Rate
Treatment Outcome