title: Extensive cytoreductive surgery for appendiceal carcinomatosis: morbidity, mortality, and survival.
abstract: BACKGROUND
  Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemoperfusion (HIPEC) are frequently used to treat appendiceal carcinomatosis. Some patients require multivisceral resection because of the volume of disease. It is unclear whether extent of CRS impacts survival in appendiceal carcinomatosis.
  
  
  METHODS
  We analyzed 282 patients undergoing attempted CRS/HIPEC for appendiceal carcinomatosis. Patients were defined as having undergone Extensive CRS (n = 60) if they had >3 organ resections or >2 anastomoses; a subgroup of Extreme CRS patients (n = 10) had ≥5 organ resections and ≥3 anastomoses. Kaplan-Meier survival curves and multivariate Cox-regression models were used to identify prognostic factors affecting outcomes.
  
  
  RESULTS
  Relative to the comparison group, patients undergoing Extensive CRS had a higher median peritoneal carcinomatosis index, operative duration, blood loss, and length of stay. No difference in completeness of cytoreduction, severe morbidity, or 60-day mortality was evident. Subgroup analysis of 10 patients undergoing extreme CRS likewise revealed no increase in severe morbidity or mortality. Median progression-free (PFS) and overall survival (OS) were 23.5 and 74 months in the comparison group; 18.5 (p = 0.086) and 51 (p = 0.85) months in the Extensive CRS group; and 40 months and not reached in the Extreme CRS subgroup. In a multivariable analysis, extent of CRS was not independently associated with PFS or OS.
  
  
  CONCLUSIONS
  Extensive CRS is associated with greater OR time, blood loss, and length of stay, but is not associated with higher morbidity, mortality, or inferior oncologic outcomes in patients with appendiceal carcinomatosis.
authors: Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. ptrckwgnr@gmail.com
authors: Patrick L
authors: PL
authors: Wagner
authors: Frances
authors: F
authors: Austin
authors: Ugwuji
authors: U
authors: Maduekwe
authors: Arun
authors: A
authors: Mavanur
authors: Lekshmi
authors: L
authors: Ramalingam
authors: Heather L
authors: HL
authors: Jones
authors: Matthew P
authors: MP
authors: Holtzman
authors: Steven A
authors: SA
authors: Ahrendt
authors: Amer H
authors: AH
authors: Zureikat
authors: James F
authors: JF
authors: Pingpank
authors: Herbert J
authors: HJ
authors: Zeh
authors: David L
authors: DL
authors: Bartlett
authors: Haroon A
authors: HA
authors: Choudry
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001062:Appendectomy / Q000401:mortality*; D001063:Appendiceal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery / Q000628:therapy; D018279:Carcinoma, Signet Ring Cell / Q000401:mortality* / Q000556:secondary / Q000601:surgery / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D010478:Chemotherapy, Cancer, Regional Perfusion; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006979:Hyperthermia, Induced; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology / Q000601:surgery / Q000628:therapy; D010534:Peritoneal Neoplasms / Q000401:mortality* / Q000556:secondary / Q000601:surgery / Q000628:therapy; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate