title: Repeated cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in peritoneal carcinomatosis from appendiceal cancer: analysis of survival outcomes.
abstract: BACKGROUND
  Cytoreductive surgery (CRS)/hyperthermic intraperitoneal chemotherapy (HIPEC) is the procedure of choice in patients with peritoneal dissemination from appendiceal cancer. Although recurrence rates are 26%-44% after first CRS/HIPEC, the role of repeated CRS/HIPEC has not been well defined. We hypothesize that patients undergoing multiple CRS/HIPEC's have meaningful long term survival.
  
  
  METHODS
  A retrospective study of a prospective database of 294 patients with peritoneal carcinomatosis (PC) was conducted, of these 162 had PC of appendiceal origin. Twenty-six of these patients underwent 56 CRS/HIPEC. Survival and outcomes was analyzed.
  
  
  RESULTS
  The percentage of patients with pre-surgical PCI scores ≥ 20 for the first, second, and third CRS/HIPEC was 65, 65, and 25%, respectively. Complete cytoreduction (CC 0-1) at first, second, and, third surgeries was 96, 65 and 75%, respectively. The mean operating time was 10.1 h. There was no 30-day peri-operative mortality. Following the first, second, and third CRS/HIPEC 27, 42, and 50% experienced grade III complications, respectively. Mean follow up was 51, 28, and 16 months from the first, second, and third CRS/HIPEC, respectively. Overall survival rate for the first CRS/HIPEC was 100, 83, 54, and 46% at years 1, 3, 5 and 10, respectively; from the second CRS/HIPEC 91, 53, and 34% at 1, 3, and 5 years, respectively; and from the third CRS/HIPEC was 75% at one year.
  
  
  CONCLUSIONS
  Repeat CRS/HIPEC can lead to meaningful long term survival rates in patients with appendiceal peritoneal carcinomatosis with morbidity and mortality similar to those of the initial CRS/HIPEC.
authors.affiliation: Institute for Cancer Care, Mercy Medical Center, 227 St. Paul Place, Baltimore, MD 21202-2001, USA. Electronic address: asardi@mdmercy.com.
authors.forename: A
authors.initials: A
authors.lastname: Sardi
authors.forename: W A
authors.initials: WA
authors.lastname: Jimenez
authors.forename: C
authors.initials: C
authors.lastname: Nieroda
authors.forename: M
authors.initials: M
authors.lastname: Sittig
authors.forename: R
authors.initials: R
authors.lastname: Macdonald
authors.forename: V
authors.initials: V
authors.lastname: Gushchin
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D001063:Appendiceal Neoplasms / Q000473:pathology*; D016190:Carboplatin / Q000008:administration & dosage; D002277:Carcinoma / Q000188:drug therapy / Q000401:mortality* / Q000556:secondary / Q000601:surgery / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D016208:Databases, Factual; D013505:Digestive System Surgical Procedures / Q000009:adverse effects; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D007263:Infusions, Parenteral; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008558:Melphalan / Q000008:administration & dosage; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D010534:Peritoneal Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000556:secondary / Q000601:surgery / Q000628:therapy*; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D016685:Mitomycin; D016190:Carboplatin; D008558:Melphalan
keywords: Appendix cancer; Cytoreductive surgery; HIPEC; Peritoneal carcinomatosis; Repeated HIPEC; Survival