title: Appendiceal goblet cell carcinomatosis treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.
abstract: BACKGROUND
  Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is a treatment commonly applied to peritoneal surface disease from low-grade mucinous tumors of the appendix. Some centers have extended this therapy to carcinomatosis from more aggressive malignancies. Therefore, we reviewed our experience with CRS/HIPEC for patients with goblet cell carcinomatosis.
  
  
  METHODS
  Patients with carcinomatosis from appendiceal primaries with goblet cell features were identified in a prospectively maintained database of 1198 CRS/HIPEC procedures performed between 1991 and 2014. Patient demographics, disease characteristics, morbidity, mortality, and survival were reviewed.
  
  
  RESULTS
  A total of 31 patients with carcinomatosis originating from appendiceal goblet cell tumors underwent CRS/HIPEC during the study period. Patients were generally young (mean age, 53 y) and otherwise healthy (84% without comorbidities) with good performance status (94% Eastern Cooperative Oncology Group 0 or 1). The mean number of visceral resections was 3.5, and complete cytoreduction of macroscopic disease was accomplished in 36%. Major 90-d morbidity and mortality rates were 38.7% and 9.7%, respectively. Median overall survival (OS) for all patients was 18.4 mo. Patients with negative nodes had better survival than those with positive nodes (median OS, 29.2 versus 10.2 mo), respectively (P = 0.002). Although complete cytoreduction was associated with longer median OS after CRS/HIPEC (R0/R1 28.6 versus R2 17.2 mo, P = 0.47), the observed difference did not reach statistical significance.
  
  
  CONCLUSIONS
  CRS/HIPEC may improve survival in patients with node negative goblet cell carcinomatosis when a complete cytoreduction is achieved. Patients with disease not amenable to complete cytoreduction should not be offered CRS/HIPEC.
authors.affiliation: Section of Surgical Oncology, Department of General Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina.
authors.forename: Reese W
authors.initials: RW
authors.lastname: Randle
authors.affiliation: Section of Surgical Oncology, Department of General Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina.
authors.forename: Kayla F
authors.initials: KF
authors.lastname: Griffith
authors.affiliation: Department of Biostatistics, Wake Forest Baptist Health, Winston-Salem, North Carolina.
authors.forename: Nora F
authors.initials: NF
authors.lastname: Fino
authors.affiliation: Department of Biostatistics, Wake Forest Baptist Health, Winston-Salem, North Carolina.
authors.forename: Katrina R
authors.initials: KR
authors.lastname: Swett
authors.affiliation: Section of Surgical Oncology, Department of General Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina.
authors.forename: John H
authors.initials: JH
authors.lastname: Stewart
authors.affiliation: Section of Surgical Oncology, Department of General Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina.
authors.forename: Perry
authors.initials: P
authors.lastname: Shen
authors.affiliation: Section of Surgical Oncology, Department of General Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina.
authors.forename: Edward A
authors.initials: EA
authors.lastname: Levine
authors.affiliation: Section of Surgical Oncology, Department of General Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina. Electronic address: kvotanop@wakehealth.edu.
authors.forename: Konstantinos I
authors.initials: KI
authors.lastname: Votanopoulos
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D001063:Appendiceal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D002277:Carcinoma / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D065426:Cytoreduction Surgical Procedures; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D009657:North Carolina / Q000453:epidemiology; D012189:Retrospective Studies
chemical_list: D000970:Antineoplastic Agents
keywords: Appendiceal cancer; Appendiceal tumor; Carcinomatosis; Cytoreductive surgery; Goblet cell; HIPEC; Neuroendocrine tumors