title: Early postoperative intraperitoneal chemotherapy following cytoreductive surgery for appendiceal mucinous neoplasms with isolated peritoneal metastasis.
abstract: BACKGROUND
  Although cytoreductive surgery and intraperitoneal chemotherapy have been advocated as standard treatment for appendiceal neoplasms with isolated peritoneal metastasis, the optimal method of chemotherapy administration has not been established. At our institution, patients undergoing complete cytoreduction in this setting typically receive multiple cycles of early postoperative intraperitoneal chemotherapy.
  
  
  OBJECTIVE
  The aim of this study was to describe patients with appendiceal neoplasms and peritoneal dissemination treated with complete cytoreductive surgery and early postoperative intraperitoneal chemotherapy and to document associated time to progression and morbidity.
  
  
  METHODS
  This is a retrospective study at a single specialty institution. Hospital and departmental databases were searched for patients presenting with primary appendiceal neoplasms undergoing cytoreductive surgery, placement of intraperitoneal port, and subsequent intraperitoneal chemotherapy from June 1995 to September 2009.
  
  
  METHODS
  This study was conducted at Memorial Sloan-Kettering Cancer Center.
  
  
  METHODS
  We identified 50 patients (30 female), median age 48 (range, 26-66) who met the criteria.
  
  
  METHODS
  Cytoreductive surgery, placement intraperitoneal port, and intraperitoneal chemotherapy were performed.
  
  
  RESULTS
  All patients underwent intraperitoneal catheter placement after complete cytoreductive surgery, followed by a median of 4 cycles (range, 1-9) intraperitoneal 5-fluoro-2'-deoxyuridine (1000 mg/m daily for 3 days) plus leucovorin (240 mg/m). The median hospital length of stay was 9 days (maximum, 29). Thirty-four percent of the patients experienced complications; 12% experienced major complications (3 abdominal abscesses, 1 deep vein thrombosis, 1 abdominal hemorrhage, and 1 intraperitoneal port malfunction). There were no 30-day mortalities. Five-year recurrence-free interval was observed in 43%. Among 23 patients with recurrence, 18 had a recurrence only within the peritoneum. The median overall survival was 9.8 years.
  
  
  CONCLUSIONS
  This is a retrospective study. Many patients had surgery first at other institutions; therefore, pathologic examination of resected material was not possible in every case. Other factors possibly impacting time to recurrence (ie, preoperative chemotherapy, duration between onset of disease and presentation to our institution) varied among patients and were not controlled for. In the absence of a control arm undergoing complete cytoreduction without early postoperative intraperitoneal chemotherapy, we did not ascertain whether intraperitoneal chemotherapy confers additional benefit.
  
  
  CONCLUSIONS
  Cytoreductive surgery plus multiple cycles of early postoperative intraperitoneal chemotherapy is safe, achieving survival results similar to published outcomes of other protocols (including hyperthermic intraperitoneal chemotherapy). Prospective trials are warranted to compare various methods of intraperitoneal chemotherapy in this setting.
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: Patrick L
authors.initials: PL
authors.lastname: Wagner
authors.forename: Douglas
authors.initials: D
authors.lastname: Jones
authors.forename: Anna
authors.initials: A
authors.lastname: Aronova
authors.forename: Jinru
authors.initials: J
authors.lastname: Shia
authors.forename: Martin R
authors.initials: MR
authors.lastname: Weiser
authors.forename: Larissa K
authors.initials: LK
authors.lastname: Temple
authors.forename: Ki Y
authors.initials: KY
authors.lastname: Chung
authors.forename: Eileen M
authors.initials: EM
authors.lastname: O'Reilly
authors.forename: David
authors.initials: D
authors.lastname: Kelsen
authors.forename: Philip B
authors.initials: PB
authors.lastname: Paty
authors.forename: Garrett M
authors.initials: GM
authors.lastname: Nash
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001063:Appendiceal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D003131:Combined Modality Therapy; D018450:Disease Progression; D004334:Drug Administration Schedule; D005260:Female; D005467:Floxuridine / Q000008:administration & dosage; D006801:Humans; D007263:Infusions, Parenteral; D002955:Leucovorin / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010534:Peritoneal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D005467:Floxuridine; D002955:Leucovorin