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Critical Analysis of Treatment Failure After Complete Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy for Peritoneal Dissemination From Appendiceal Mucinous Neoplasms

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Cytoreductive surgery (CRS) combined with perioperative intraperitoneal chemotherapy (PIC) has been suggested as a treatment strategy for peritoneal carcinomatosis. The objective of this data analysis was to study treatment failure after complete cytoreduction for peritoneal dissemination from appendiceal mucinous neoplasms.

Methods

Before June 2006, a total of 402 patients with peritoneal dissemination from appendiceal mucinous neoplasms underwent complete cytoreduction and PIC at the Washington Cancer Institute. Patient characteristics, pathologic features, and treatment-related data were obtained from a prospective database. Survival analyses were performed by the Kaplan-Meier method and the Cox regression model.

Results

After a median follow-up of 66 months, the 5- and 10-year progression-free survival rates for these 402 patients were 70% and 67%, respectively. Disease progression was the only independent risk factor for a reduced overall survival. One hundred eleven patients (28%) developed progressive disease. Of these, 98 patients underwent second-time and 26 patients third-time CRS and PIC. Complete cytoreduction after repeat surgery was the only independent prognostic factor for improved survival. The most common sites of treatment failure were on the small bowel and in the pelvis.

Conclusions

The present study reported the patterns of treatment failure after complete cytoreduction and demonstrated that a disease-free state is important for long-term survival in peritoneal dissemination from appendiceal mucinous neoplasms. Repeat complete cytoreduction should be pursued when possible and is associated with improved overall survival in patients with recurrent disease.

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Acknowledgments

Tristan D. Yan and Lana Bijelic are surgical oncology research fellows supported by Foundation for Applied Research in Gastrointestinal Oncology. We thank David Chang for his assistance with the statistical analysis.

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Authors and Affiliations

  1. Peritoneal Surface Malignancy Program, Washington Cancer Institute, Washington Hospital Center, 106 Irving Street NW, Suite 3900N, Washington, DC, 20010, USA

    Tristan D. Yan BSc (Med) MBBS, Lana Bijelic MD & Paul H. Sugarbaker MD

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  1. Tristan D. Yan BSc (Med) MBBS
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  2. Lana Bijelic MD
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  3. Paul H. Sugarbaker MD
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Corresponding author

Correspondence to Paul H. Sugarbaker MD.

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Yan, T.D., Bijelic, L. & Sugarbaker, P.H. Critical Analysis of Treatment Failure After Complete Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy for Peritoneal Dissemination From Appendiceal Mucinous Neoplasms. Ann Surg Oncol 14, 2289–2299 (2007). https://doi.org/10.1245/s10434-007-9462-0

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  • DOI: https://doi.org/10.1245/s10434-007-9462-0

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