title: Extensive surgical history prior to cytoreductive surgery and hyperthermic intraperitoneal chemotherapy is associated with poor survival outcomes in patients with peritoneal mucinous carcinomatosis of appendiceal origin.
abstract: BACKGROUND
  Patients with PMCA commonly undergo surgery before CRS/HIPEC. We evaluated the role of extensive surgical treatment before CRS/HIPEC in terms of overall survival (OS).
  
  
  METHODS
  105 patients with PMCA who underwent a CRS/HIPEC procedure were identified from a prospective database. Patients were divided into two groups based on Prior Surgery Score (PSS): PSS ≤ 1 limited surgery group (LSG), PSS >1 extensive surgery group (ESG). Survival of lymph node (LN) negative and positive patients was analyzed separately.
  
  
  RESULTS
  40 patients were in LSG and 65 in ESG. Mean time from diagnosis to CRS/HIPEC was 6 and 17 months for LSG and ESG, respectively (p = 0.004). Groups were well balanced in peritoneal cancer index, complete cytoreduction rate, and LN status. One, 3, and 5-year OS among LN negative patients was 95, 83, and 75% for the LSG (n = 22) group and 87, 55, and 32% for the ESG (n = 35), group respectively (p = 0.026). One, 3, and 5-year OS among LN positive patients was 69, 50, and 17% for the LSG (n = 18) group and 80, 21, and 14% for the ESG (n = 30), group respectively (p = 0.613). For all patients 1, 3, and 5-year OS was 84, 65, and 54% for the LSG (n = 40) group and 86, 43, and 26% for the ESG (n = 65) group, respectively (p = 0.029).
  
  
  CONCLUSIONS
  Extensive surgical treatment before CRS/HIPEC is associated with delay of CRS/HIPEC and poorer OS overall, especially among LN negative patients. We recommend early referral of PMCA patients to a peritoneal surface malignancy center.
authors.affiliation: Department of Surgical Oncology, Mercy Medical Center, 227 St Paul Place, Baltimore, MD 21202-2001, USA. Electronic address: vmilovan@mdmercy.com.
authors.forename: V
authors.initials: V
authors.lastname: Milovanov
authors.affiliation: Department of Surgical Oncology, 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.affiliation: Department of Surgical Oncology, Mercy Medical Center, 227 St Paul Place, Baltimore, MD 21202-2001, USA. Electronic address: naydin@mdmercy.com.
authors.forename: N
authors.initials: N
authors.lastname: Aydin
authors.affiliation: Department of Surgical Oncology, Mercy Medical Center, 227 St Paul Place, Baltimore, MD 21202-2001, USA. Electronic address: cnieroda@mdmercy.com.
authors.forename: C
authors.initials: C
authors.lastname: Nieroda
authors.affiliation: Department of Surgical Oncology, Mercy Medical Center, 227 St Paul Place, Baltimore, MD 21202-2001, USA. Electronic address: msittig@mdmercy.com.
authors.forename: M
authors.initials: M
authors.lastname: Sittig
authors.affiliation: Department of Surgical Oncology, Mercy Medical Center, 227 St Paul Place, Baltimore, MD 21202-2001, USA. Electronic address: mnunez@mdmercy.com.
authors.forename: M
authors.initials: M
authors.lastname: Nunez
authors.affiliation: Department of Surgical Oncology, Mercy Medical Center, 227 St Paul Place, Baltimore, MD 21202-2001, USA. Electronic address: vgushchin@mdmercy.com.
authors.forename: V
authors.initials: V
authors.lastname: Gushchin
mesh_terms: D000005:Abdomen / Q000601:surgery*; D002288:Adenocarcinoma, Mucinous / Q000188:drug therapy / Q000556:secondary / Q000601:surgery / Q000628:therapy*; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001063:Appendiceal Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000379:methods; D065426:Cytoreduction Surgical Procedures; D013505:Digestive System Surgical Procedures / Q000009:adverse effects; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects; D059685:Herniorrhaphy / Q000009:adverse effects; D006801:Humans; D006979:Hyperthermia, Induced; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000188:drug therapy / Q000556:secondary / Q000601:surgery / Q000628:therapy*; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000009:adverse effects*; D016896:Treatment Outcome
keywords: Cytoreductive surgery/HIPEC; Mucinous appendiceal neoplasms; Survival