Incomplete cytoreduction with peritoneal metastases from appendiceal mucinous neoplasms.
Humans
Cytoreduction Surgical Procedures
/ adverse effects
Peritoneal Neoplasms
/ surgery
Retrospective Studies
Hyperthermia, Induced
/ adverse effects
Prospective Studies
Ascites
/ etiology
Survival Rate
Appendiceal Neoplasms
/ surgery
Adenocarcinoma, Mucinous
/ surgery
Antineoplastic Combined Chemotherapy Protocols
/ therapeutic use
Combined Modality Therapy
EPIC
HIPEC
completeness of cytoreduction score
peritoneal cancer index
peritonectomy
total colectomy
visceral resections
Journal
Journal of surgical oncology
ISSN: 1096-9098
Titre abrégé: J Surg Oncol
Pays: United States
ID NLM: 0222643
Informations de publication
Date de publication:
Dec 2022
Dec 2022
Historique:
received:
18
08
2022
accepted:
28
08
2022
pubmed:
15
9
2022
medline:
15
11
2022
entrez:
14
9
2022
Statut:
ppublish
Résumé
Complete cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy is the standard of care for mucinous appendiceal neoplasms with peritoneal metastases. Despite many publications regarding selection factors favoring a complete CRS, incomplete CRS does occur. Patients with an incomplete CRS are the focus of this manuscript. A retrospective analysis of prospective, histologic, and perioperative data was performed. Overall survival was the endpoint for the numerous assessments. Judgments regarding when to and when not to proceed with an incomplete CRS were sought. From a database of 949 patients who underwent an index CRS for appendiceal mucinous neoplasm, 264 patients (27.8%) had an incomplete CRS. The median overall survival was 1.8 years. Low-grade histopathology and absence of tense ascites or bowel obstruction were significantly associated with increased overall survival. More extensive surgery suggested a more favorable outcome. When a surgeon is confronted by a procedure that will inevitably end with an incomplete CRS, a current trend is to close quickly and always avoid complications. Patients with low-grade neoplasms who present in the absence of tense ascites or bowel obstruction may gain years of survival by surgical reduction of tumor burden.
Sections du résumé
BACKGROUND
BACKGROUND
Complete cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy is the standard of care for mucinous appendiceal neoplasms with peritoneal metastases. Despite many publications regarding selection factors favoring a complete CRS, incomplete CRS does occur. Patients with an incomplete CRS are the focus of this manuscript.
METHODS
METHODS
A retrospective analysis of prospective, histologic, and perioperative data was performed. Overall survival was the endpoint for the numerous assessments. Judgments regarding when to and when not to proceed with an incomplete CRS were sought.
RESULTS
RESULTS
From a database of 949 patients who underwent an index CRS for appendiceal mucinous neoplasm, 264 patients (27.8%) had an incomplete CRS. The median overall survival was 1.8 years. Low-grade histopathology and absence of tense ascites or bowel obstruction were significantly associated with increased overall survival. More extensive surgery suggested a more favorable outcome.
CONCLUSIONS
CONCLUSIONS
When a surgeon is confronted by a procedure that will inevitably end with an incomplete CRS, a current trend is to close quickly and always avoid complications. Patients with low-grade neoplasms who present in the absence of tense ascites or bowel obstruction may gain years of survival by surgical reduction of tumor burden.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1462-1470Subventions
Organisme : Foundation for Applied Research in Gastrointestinal Oncology
Informations de copyright
© 2022 Wiley Periodicals LLC.
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