Novel Application of Iterative Hyperthermic Intraperitoneal Chemotherapy for Unresectable Peritoneal Metastases from High-Grade Appendiceal Ex-Goblet Adenocarcinoma

Yaniv Berger, Darryl Schuitevoerder, Charles C. Vining, Lindsay Alpert, Emily Fenton, Enal Hindi, Chih Yi Liao, Ardaman Shergill, Daniel V.T. Catenacci, Blase N. Polite, Oliver S. Eng, Kiran K. Turaga

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Background: Peritoneal metastases (PMs) from appendiceal ex-goblet adenocarcinoma (AEGA) are associated with a poor prognosis. While cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) has been shown to prolong survival, the majority of patients are ineligible for complete cytoreduction. We describe a novel approach to the management of such patients with iterative HIPEC (IHIPEC). Methods: Patients with signet ring/poorly differentiated AEGA with high Peritoneal Cancer Index (PCI) and extensive bowel involvement underwent IHIPEC with mitomycin C at 6-week intervals for a total of three cycles. Survival outcomes for these patients were compared with patients with high-grade appendiceal tumors matched for tumor burden who were treated with other conventional approaches, i.e. systemic chemotherapy only (SCO) or complete CRS + HIPEC. Results: Between 2016 and 2019, seven AEGA patients with high PCI (median 32.5 [range 21–36]) underwent 18 IHIPEC cycles (median cycles per patient 3 [2–3]) in combination with systemic chemotherapy (median 2 lines [1–3], 12 cycles [10–28]). IHIPEC was delivered laparoscopically in 14/18 cases. Postoperatively, the median length of stay was 1 day (1–8 days), no procedure-related complications were reported, and five (28%) 90-day readmissions for bowel obstruction were documented. Median overall survival after IHIPEC was better compared with a matched group of patients (n = 16) receiving SCO (24.6 vs. 7.9 months; p = 0.005), and similar to those (n = 7) who underwent CRS + HIPEC (24.6 vs. 16.5 months; p = 0.62). Conclusions: IHIPEC in combination with systemic chemotherapy is tolerable, safe, and may be associated with encouraging survival outcomes compared with SCO in selected patients with high-grade, high-burden AEGA PM.

Original languageEnglish (US)
Pages (from-to)1777-1785
Number of pages9
JournalAnnals of Surgical Oncology
Issue number3
StatePublished - Mar 2021

All Science Journal Classification (ASJC) codes

  • Surgery
  • Oncology

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