How to improve outcome in patients with primary appendiceal mucinous cancer

Appendiceal mucinous cancers are extremely rare cancers. The management of mucinous appendiceal tumors is mainly based on single-institution experiences. A challenge in the treatment of this disease is that a large number of patients present with disease that has spread throughout the belly involving the surface of organs like the intestines and liver. Surgical removal of the cancer is the mainstay of therapy. Hyperthermic intraperitoneal chemotherapy (HIPEC) is the infusion of heated chemotherapy into the belly during surgery. This is done after complete removal of the cancer. This procedure takes about 30 minutes after which the belly is closed. The role of HIPEC in this treatment of appendiceal tumors is controversial.

In this original report, we reviewed the management and outcomes of this disease at three tertiary care cancer institutes. Two of the three routinely use HIPEC, and one institution does not. Around half of our patients received HIPEC. We compared the survival of patients who received HIPEC after surgery to those who did not. We found that the use of HIPEC prolongs the life of patients. Patients who received HIPEC after surgery lived an average of 77 months as compared to 25 months for those who did not receive it. This paper clearly highlights the role of HIPEC in the management of appendiceal mucinous tumors.

We also highlighted the importance of completely removing the tumor at the time of surgery defined as not being able to see any cancer in the abdomen after surgery. Around 70% of patients who achieved complete removal of the cancer were alive at 60-month follow up. This is compared to only 25% of patients being alive at 60 months of follow up.

Management of appendiceal tumors requires high level of expertise to ensure optimal surgery with removal of all visible cancer. Addition of HIPEC in that setting seems to be beneficial. Referral of patients to tertiary cancer centers with experience in management of appendiceal tumors is essential to obtain best outcomes.

Walid L. Shaib, MD and Bassel F. El-Rayes, MD

Department of Hematology and Oncology, Winship Cancer Institute
Emory University, Atlanta, Georgia, USA

 

Publication

Hyperthermic Intraperitoneal Chemotherapy Following Cytoreductive Surgery Improves Outcome in Patients With Primary Appendiceal Mucinous Adenocarcinoma: A Pooled Analysis From Three Tertiary Care Centers.
Shaib WL, Martin LK, Choi M, Chen Z, Krishna K, Kim S, Brutcher E, Staley C 3rd, Maithel SK, Philip P, Abdel-Misih S, Bekaii-Saab TS, El-Rayes BF
Oncologist. 2015 Aug

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