Third look surgery and beyond for appendiceal malignancy with peritoneal dissemination.
OBJECTIVE
Second look surgery has been previously studied in patients with recurrent peritoneal dissemination from appendiceal malignancy. However, selection criteria for third, fourth, and subsequent reoperations are not available.


METHODS
Five hundred and one patients with epithelial peritoneal surface malignancy of appendiceal origin underwent treatment with cytoreductive surgery and intraperitoneal chemotherapy during an 18-year period. Forty-five of these patients (8.9%) underwent three or more operative interventions. A critical statistical analysis of the impact of selected clinical features on survival was performed from a prospective database.


RESULTS
Overall 5-year survival of these 45 patients was 70%. Five- and ten-year survival rates for patients with three interventions were 60 and 48%, for four interventions were 78 and 36%, and for five or more interventions were 100 and 80%. Sites of recurrent disease, histopathologic type of tumor, and lymph node status had no impact on survival. A complete second and third cytoreduction was associated with an improved 5-year survival rate.


CONCLUSIONS
Prolonged survival in patients with three or more reoperations was significantly associated with a complete cytoreduction. However, after four or more interventions, the effects of tumor biology may predominate. Although 5-year survival is likely with multiple reoperations, prolonged follow-up shows that cancer cure is a rare event.
The Washington Cancer Institute, Washington Hospital Center, Washington, DC 20010, USA.
Faheez
F
Mohamed
David
D
Chang
Paul H
PH
Sugarbaker
D002288:Adenocarcinoma, Mucinous / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001063:Appendiceal Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D007263:Infusions, Parenteral; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D009364:Neoplasm Recurrence, Local; D010534:Peritoneal Neoplasms / Q000401:mortality / Q000473:pathology*; D012086:Reoperation; D015996:Survival Rate
D016685:Mitomycin; D005472:Fluorouracil