title: Prophylactic hyperthermic intraperitoneal chemotherapy in patients with epithelial appendiceal neoplasms.
abstract: Background Prophylactic hyperthermic intraperitoneal chemotherapy (HIPEC) is a promising approach for preventing peritoneal carcinomatosis in high-risk patients. We report our initial experience with prophylactic HIPEC in a series of patients with appendiceal neoplasms. Methods We retrospectively reviewed our prospectively maintained database to identify patients who underwent HIPEC in the absence of peritoneal disease. Patients with previously documented peritoneal surface disease were excluded. Data regarding clinical, operative and pathological features were analysed. Results Out of 322 HIPEC procedures performed between March 2007and August 2015, we identified 16 patients who underwent surgery with prophylactic intent. Primary diagnoses included high-grade and low-grade appendiceal neoplasms. Most patients presented originally with appendiceal perforation; all patients underwent initial surgery during which the appendix or right colon were resected. Following a median time interval of 2.2 months, a second surgery performed at our institution consisted of completion of omentectomy, partial colectomy and oophorectomy, with administration of prophylactic HIPEC (using mitomycin C). A totally laparoscopic approach was attempted and achieved in 11 patients in whom the median duration of surgery, estimated intraoperative blood loss and length of hospitalisation were 251 min, 100 cm(3) and 4 days, respectively. There were no cases of major perioperative morbidity or mortality. Conclusions Prophylactic HIPEC for appendiceal neoplasms is feasible, safe and may be performed laparoscopically. Larger studies with long-term follow-up are needed to determine whether a survival benefit is associated with this treatment.
authors.affiliation: a Department of Surgery, Division of Surgical Oncology , Icahn School of Medicine at Mount Sinai , New York ;
authors.forename: Daniel
authors.initials: D
authors.lastname: Tuvin
authors.affiliation: a Department of Surgery, Division of Surgical Oncology , Icahn School of Medicine at Mount Sinai , New York ;
authors.forename: Yaniv
authors.initials: Y
authors.lastname: Berger
authors.affiliation: a Department of Surgery, Division of Surgical Oncology , Icahn School of Medicine at Mount Sinai , New York ;
authors.forename: Samantha N
authors.initials: SN
authors.lastname: Aycart
authors.affiliation: b Department of Pathology , Icahn School of Medicine at Mount Sinai , New York , USA.
authors.forename: Tatiana
authors.initials: T
authors.lastname: Shtilbans
authors.affiliation: a Department of Surgery, Division of Surgical Oncology , Icahn School of Medicine at Mount Sinai , New York ;
authors.forename: Spiros
authors.initials: S
authors.lastname: Hiotis
authors.affiliation: a Department of Surgery, Division of Surgical Oncology , Icahn School of Medicine at Mount Sinai , New York ;
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Labow
authors.affiliation: a Department of Surgery, Division of Surgical Oncology , Icahn School of Medicine at Mount Sinai , New York ;
authors.forename: Umut
authors.initials: U
authors.lastname: Sarpel
mesh_terms: D000328:Adult; D000368:Aged; D000903:Antibiotics, Antineoplastic / Q000627:therapeutic use*; D001063:Appendiceal Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000628:therapy*; D010478:Chemotherapy, Cancer, Regional Perfusion; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000627:therapeutic use*; D010534:Peritoneal Neoplasms / Q000517:prevention & control*; D012189:Retrospective Studies
chemical_list: D000903:Antibiotics, Antineoplastic; D016685:Mitomycin
keywords: Appendiceal cancer; cytoreductive surgery; hyperthermic intraperitoneal chemotherapy; laparoscopy; perforation; prophylaxis