Surgery · 2026
Long-term survival after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for appendiceal neoplasms: A Brazilian cancer center experience.
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Marques Tomás M D M, Lourenco Stephanie R, Kupper Bruna E C, Bezerra Artur L R, Stevanato Paulo Roberto, Bezerra Tiago S, Takahashi Renata M, Nahime Rebeca H, Souza Virgilio, Nakagawa Wilson T, Lopes Ademar, Aguiar Samuel
Аннотация
BACKGROUND: Appendiceal neoplasms represent less than 1% of all gastrointestinal cancers. Epithelial mucinous neoplasms of the appendix are classified as low grade, high grade, or adenocarcinoma. Pseudomyxoma peritonei, the peritoneal dissemination of these tumors, is a common clinical presentation. The management of peritoneal carcinomatosis is complex and involves cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy, a modality associated with significant surgical morbidity and resource demands. Nevertheless, cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy remains the standard of care.
OBJECTIVE: To evaluate overall survival and disease-free survival following cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy for appendiceal tumors in a Latin American cancer center.
METHODS: We conducted a retrospective observational cohort study including patients aged 18-75 years who underwent cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy between 2001 and 2021. Survival analysis was performed using Kaplan-Meier estimates and the log-rank test to compare overall survival and disease-free survival up to 10 years or until last follow-up or death. Cox proportional hazards models were applied to identify risk factors associated with recurrence and mortality.
RESULTS: A total of 139 patients were included; 45.3% were male, with a mean age of 49.8 years. Fifty-four patients had mucinous neoplasms, and 85 patients had adenocarcinomas. The mean peritoneal cancer index was 14.9, and complete cytoreductive surgery was achieved in 133 patients (95.6%). The most commonly used chemotherapy agents were mitomycin (74.8%) and oxaliplatin (25.2%). At 10 years, overall survival and disease-free survival were 64.8% and 55.2%, respectively. Histology was significantly associated with prognosis (P = .04 for overall survival and P = .02 for disease-free survival at 10 years). In multivariable Cox regression, the use of oxaliplatin was associated with an increased risk of recurrence (hazard ratio, 2.71; 95% confidence interval, 1.26-5.53). Poorly differentiated or signet-ring cell histology was associated with a 3.5-fold increased risk of recurrence (hazard ratio, 3.54; 95% confidence interval, 1.44-8.68) and a 3-fold increased risk of death (hazard ratio, 2.9; 95% confidence interval, 1.14-7.26).
CONCLUSION: Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy is a complex but effective treatment for appendiceal neoplasms, providing favorable long-term survival rates with acceptable mortality when performed at experienced referral centers. Our study suggests that both the hyperthermic intraperitoneal chemotherapy drug and histological subtype influenced disease-free survival. These findings underscore the importance of careful patient selection and specialized multidisciplinary care to optimize outcomes.
OBJECTIVE: To evaluate overall survival and disease-free survival following cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy for appendiceal tumors in a Latin American cancer center.
METHODS: We conducted a retrospective observational cohort study including patients aged 18-75 years who underwent cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy between 2001 and 2021. Survival analysis was performed using Kaplan-Meier estimates and the log-rank test to compare overall survival and disease-free survival up to 10 years or until last follow-up or death. Cox proportional hazards models were applied to identify risk factors associated with recurrence and mortality.
RESULTS: A total of 139 patients were included; 45.3% were male, with a mean age of 49.8 years. Fifty-four patients had mucinous neoplasms, and 85 patients had adenocarcinomas. The mean peritoneal cancer index was 14.9, and complete cytoreductive surgery was achieved in 133 patients (95.6%). The most commonly used chemotherapy agents were mitomycin (74.8%) and oxaliplatin (25.2%). At 10 years, overall survival and disease-free survival were 64.8% and 55.2%, respectively. Histology was significantly associated with prognosis (P = .04 for overall survival and P = .02 for disease-free survival at 10 years). In multivariable Cox regression, the use of oxaliplatin was associated with an increased risk of recurrence (hazard ratio, 2.71; 95% confidence interval, 1.26-5.53). Poorly differentiated or signet-ring cell histology was associated with a 3.5-fold increased risk of recurrence (hazard ratio, 3.54; 95% confidence interval, 1.44-8.68) and a 3-fold increased risk of death (hazard ratio, 2.9; 95% confidence interval, 1.14-7.26).
CONCLUSION: Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy is a complex but effective treatment for appendiceal neoplasms, providing favorable long-term survival rates with acceptable mortality when performed at experienced referral centers. Our study suggests that both the hyperthermic intraperitoneal chemotherapy drug and histological subtype influenced disease-free survival. These findings underscore the importance of careful patient selection and specialized multidisciplinary care to optimize outcomes.