title: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in 1000 patients with perforated appendiceal epithelial tumours.
abstract: To report early and long term outcomes following cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in 1000 patients with perforated appendiceal epithelial tumours, predominantly with pseudomyxoma peritonei (PMP).
  
  
  
  Retrospective analysis of a prospective database of 1000 consecutive patients undergoing CRS and HIPEC for perforated appendiceal tumours between 1994 and 2014 in a UK National Peritoneal Malignancy unit.
  
  
  
  Overall 1000/1444 (69.2%) patients treated for peritoneal malignancy had appendiceal primary tumours. Of these 738/1000 (73.8%) underwent complete cytoreductive surgery (CCRS), 242 (24.2%) had maximal tumour debulking (MTD) and 20 (2%) had laparotomy and biopsies only. Treatment related 30-day mortality was 0.8% in CCRS and 1.7% in MTD group with major postoperative morbidity rates of 15.2% (CCRS) and 14.5% (MTD). Five- and 10-year overall survival was 87.4% and 70.3% in the 738 patients who had CCRS compared with 39.2% and 8.1% respectively in the MTD group. On multivariate analysis, significant predictors of reduced overall survival were male gender (p = 0.022), elevated CEA (p = 0.001), elevated CA125 (p = 0.001) and high tumour grade or adenocarcinoma (p = 0.001).
  
  
  
  Perforated epithelial appendiceal tumours are rare, though may be increasing in incidence and can present unexpectedly at elective or emergency abdominal surgery, often with PMP. CRS and HIPEC results in good long term outcomes in most patients.
authors.affiliation: Peritoneal Malignancy Institute, North Hampshire Hospital, Hampshire Hospital Foundation Trust, Aldermaston Road, Basingstoke, RG24 9NA, United Kingdom. Electronic address: drnabilaansari@gmail.com.
authors.forename: N
authors.initials: N
authors.lastname: Ansari
authors.affiliation: Peritoneal Malignancy Institute, North Hampshire Hospital, Hampshire Hospital Foundation Trust, Aldermaston Road, Basingstoke, RG24 9NA, United Kingdom. Electronic address: Kandiah.Chandrakumaran@hhft.nhs.uk.
authors.forename: K
authors.initials: K
authors.lastname: Chandrakumaran
authors.affiliation: Peritoneal Malignancy Institute, North Hampshire Hospital, Hampshire Hospital Foundation Trust, Aldermaston Road, Basingstoke, RG24 9NA, United Kingdom. Electronic address: sanjeevdayal@nhs.net.
authors.forename: S
authors.initials: S
authors.lastname: Dayal
authors.affiliation: Peritoneal Malignancy Institute, North Hampshire Hospital, Hampshire Hospital Foundation Trust, Aldermaston Road, Basingstoke, RG24 9NA, United Kingdom. Electronic address: faheez@btinternet.com.
authors.forename: F
authors.initials: F
authors.lastname: Mohamed
authors.affiliation: Peritoneal Malignancy Institute, North Hampshire Hospital, Hampshire Hospital Foundation Trust, Aldermaston Road, Basingstoke, RG24 9NA, United Kingdom. Electronic address: Tom.Cecil@nhs.net.
authors.forename: T D
authors.initials: TD
authors.lastname: Cecil
authors.affiliation: Peritoneal Malignancy Institute, North Hampshire Hospital, Hampshire Hospital Foundation Trust, Aldermaston Road, Basingstoke, RG24 9NA, United Kingdom. Electronic address: Brendan.Moran@hhft.nhs.uk.
authors.forename: B J
authors.initials: BJ
authors.lastname: Moran
mesh_terms: D000328:Adult; D000368:Aged; D001063:Appendiceal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D014408:Biomarkers, Tumor / Q000097:blood; D002277:Carcinoma / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D010478:Chemotherapy, Cancer, Regional Perfusion; D065426:Cytoreduction Surgical Procedures / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006979:Hyperthermia, Induced; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011553:Pseudomyxoma Peritonei / Q000188:drug therapy / Q000601:surgery; D011788:Quality of Life; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D006113:United Kingdom
chemical_list: D014408:Biomarkers, Tumor
keywords: Appendix tumours; Cytoreductive surgery; Hyperthermic intraperitoneal chemotherapy; Pseudomyxoma peritonei