title: Delay of cytoreductive surgery and heated intraperitoneal chemotherapy in patients with appendiceal neoplasm.
abstract: Cytoreductive surgery/heated intraperitoneal chemotherapy (CRS/HIPEC) has been shown to be effective for selected patients with advanced appendiceal cancer. We propose that delaying CRS/HIPEC leads to disease progression and affects outcome. A retrospective analysis of a prospective  database was carried out. Patients were divided into two groups based on time from diagnosis to CRS/HIPEC (less than 6 months = early, greater than 6 months = delayed). Comparison was made of Peritoneal Cancer Index (PCI), Prior Surgery Score (PSS), complete cytoreduction (CC), and lymph node  status. Overall survival (OS) was calculated using Kaplan-Meier estimates. Of 127 patients, 50 had disseminated peritoneal adenomucinosis and 77 had peritoneal mucinous carcinomatosis (PMCA). Of patients with PMCA, 41 had early CRS/HIPEC and 36 delayed. PCI was less than 20 in 46 and 17 per  cent (P = 0.007) of the early and delayed groups, respectively. CC was achieved in 88 and 61 per cent (P = 0.009) of the early and delayed groups, respectively. PSS was (2 of 3) in 51 and 91 per cent (P = 0.001) of the early and delayed groups, respectively. Five-year  OS was 54 per cent for the early group and 45 per cent for the delayed group (P = 0.2). Delaying CRS/HIPEC was associated with higher tumor load and lower chance for complete cytroreduction. Longer follow-up and larger numbers are needed to determine if OS difference will reach statistical  significance.
authors: Division of Surgery, Section of Surgical Oncology, Institute for Cancer Care, Mercy Medical Center, Baltimore, Maryland 21202, USA. hhalabi@mdmercy.com
authors: Hatem
authors: H
authors: El Halabi
authors: Ryan
authors: R
authors: MacDonald
authors: Kimberly
authors: K
authors: Studeman
authors: Jennifer
authors: J
authors: Francis
authors: Carol
authors: C
authors: Nieroda
authors: Vadim
authors: V
authors: Gushchin
authors: Armando
authors: A
authors: Sardi
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D001063:Appendiceal Neoplasms / Q000401:mortality / Q000473:pathology*; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000379:methods*; D003131:Combined Modality Therapy; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006979:Hyperthermia, Induced; D007263:Infusions, Parenteral; D008297:Male; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D010537:Peritoneum / Q000601:surgery*; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome