Extensive cytoreductive surgery for appendiceal carcinomatosis: Morbidity, mortality, and survival

Patrick L. Wagner, Frances Austin, Ugwuji Maduekwe, Arun Mavanur, Lekshmi Ramalingam, Heather L. Jones, Matthew P. Holtzman, Steven A. Ahrendt, Amer H. Zureikat, James F. Pingpank, Herbert J. Zeh, David L. Bartlett, Haroon A. Choudry

Research output: Contribution to journalArticle

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Abstract

Background: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemoperfusion (HIPEC) are frequently used to treat appendiceal carcinomatosis. Some patients require multivisceral resection because of the volume of disease. It is unclear whether extent of CRS impacts survival in appendiceal carcinomatosis. Methods: We analyzed 282 patients undergoing attempted CRS/HIPEC for appendiceal carcinomatosis. Patients were defined as having undergone Extensive CRS (n = 60) if they had >3 organ resections or >2 anastomoses; a subgroup of Extreme CRS patients (n = 10) had ≥5 organ resections and ≥3 anastomoses. Kaplan-Meier survival curves and multivariate Cox-regression models were used to identify prognostic factors affecting outcomes. Results: Relative to the comparison group, patients undergoing Extensive CRS had a higher median peritoneal carcinomatosis index, operative duration, blood loss, and length of stay. No difference in completeness of cytoreduction, severe morbidity, or 60-day mortality was evident. Subgroup analysis of 10 patients undergoing extreme CRS likewise revealed no increase in severe morbidity or mortality. Median progression-free (PFS) and overall survival (OS) were 23.5 and 74 months in the comparison group; 18.5 (p = 0.086) and 51 (p = 0.85) months in the Extensive CRS group; and 40 months and not reached in the Extreme CRS subgroup. In a multivariable analysis, extent of CRS was not independently associated with PFS or OS. Conclusions: Extensive CRS is associated with greater OR time, blood loss, and length of stay, but is not associated with higher morbidity, mortality, or inferior oncologic outcomes in patients with appendiceal carcinomatosis.

Original languageEnglish (US)
Pages (from-to)1056-1062
Number of pages7
JournalAnnals of Surgical Oncology
Volume20
Issue number4
DOIs
StatePublished - Apr 1 2013
Externally publishedYes

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Morbidity
Carcinoma
Survival
Mortality
Length of Stay
Kaplan-Meier Estimate
Proportional Hazards Models

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Wagner, P. L., Austin, F., Maduekwe, U., Mavanur, A., Ramalingam, L., Jones, H. L., ... Choudry, H. A. (2013). Extensive cytoreductive surgery for appendiceal carcinomatosis: Morbidity, mortality, and survival. Annals of Surgical Oncology, 20(4), 1056-1062. https://doi.org/10.1245/s10434-012-2791-7

Extensive cytoreductive surgery for appendiceal carcinomatosis : Morbidity, mortality, and survival. / Wagner, Patrick L.; Austin, Frances; Maduekwe, Ugwuji; Mavanur, Arun; Ramalingam, Lekshmi; Jones, Heather L.; Holtzman, Matthew P.; Ahrendt, Steven A.; Zureikat, Amer H.; Pingpank, James F.; Zeh, Herbert J.; Bartlett, David L.; Choudry, Haroon A.

In: Annals of Surgical Oncology, Vol. 20, No. 4, 01.04.2013, p. 1056-1062.

Research output: Contribution to journalArticle

Wagner, PL, Austin, F, Maduekwe, U, Mavanur, A, Ramalingam, L, Jones, HL, Holtzman, MP, Ahrendt, SA, Zureikat, AH, Pingpank, JF, Zeh, HJ, Bartlett, DL & Choudry, HA 2013, 'Extensive cytoreductive surgery for appendiceal carcinomatosis: Morbidity, mortality, and survival', Annals of Surgical Oncology, vol. 20, no. 4, pp. 1056-1062. https://doi.org/10.1245/s10434-012-2791-7
Wagner, Patrick L. ; Austin, Frances ; Maduekwe, Ugwuji ; Mavanur, Arun ; Ramalingam, Lekshmi ; Jones, Heather L. ; Holtzman, Matthew P. ; Ahrendt, Steven A. ; Zureikat, Amer H. ; Pingpank, James F. ; Zeh, Herbert J. ; Bartlett, David L. ; Choudry, Haroon A. / Extensive cytoreductive surgery for appendiceal carcinomatosis : Morbidity, mortality, and survival. In: Annals of Surgical Oncology. 2013 ; Vol. 20, No. 4. pp. 1056-1062.
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abstract = "Background: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemoperfusion (HIPEC) are frequently used to treat appendiceal carcinomatosis. Some patients require multivisceral resection because of the volume of disease. It is unclear whether extent of CRS impacts survival in appendiceal carcinomatosis. Methods: We analyzed 282 patients undergoing attempted CRS/HIPEC for appendiceal carcinomatosis. Patients were defined as having undergone Extensive CRS (n = 60) if they had >3 organ resections or >2 anastomoses; a subgroup of Extreme CRS patients (n = 10) had ≥5 organ resections and ≥3 anastomoses. Kaplan-Meier survival curves and multivariate Cox-regression models were used to identify prognostic factors affecting outcomes. Results: Relative to the comparison group, patients undergoing Extensive CRS had a higher median peritoneal carcinomatosis index, operative duration, blood loss, and length of stay. No difference in completeness of cytoreduction, severe morbidity, or 60-day mortality was evident. Subgroup analysis of 10 patients undergoing extreme CRS likewise revealed no increase in severe morbidity or mortality. Median progression-free (PFS) and overall survival (OS) were 23.5 and 74 months in the comparison group; 18.5 (p = 0.086) and 51 (p = 0.85) months in the Extensive CRS group; and 40 months and not reached in the Extreme CRS subgroup. In a multivariable analysis, extent of CRS was not independently associated with PFS or OS. Conclusions: Extensive CRS is associated with greater OR time, blood loss, and length of stay, but is not associated with higher morbidity, mortality, or inferior oncologic outcomes in patients with appendiceal carcinomatosis.",
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T1 - Extensive cytoreductive surgery for appendiceal carcinomatosis

T2 - Morbidity, mortality, and survival

AU - Wagner, Patrick L.

AU - Austin, Frances

AU - Maduekwe, Ugwuji

AU - Mavanur, Arun

AU - Ramalingam, Lekshmi

AU - Jones, Heather L.

AU - Holtzman, Matthew P.

AU - Ahrendt, Steven A.

AU - Zureikat, Amer H.

AU - Pingpank, James F.

AU - Zeh, Herbert J.

AU - Bartlett, David L.

AU - Choudry, Haroon A.

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N2 - Background: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemoperfusion (HIPEC) are frequently used to treat appendiceal carcinomatosis. Some patients require multivisceral resection because of the volume of disease. It is unclear whether extent of CRS impacts survival in appendiceal carcinomatosis. Methods: We analyzed 282 patients undergoing attempted CRS/HIPEC for appendiceal carcinomatosis. Patients were defined as having undergone Extensive CRS (n = 60) if they had >3 organ resections or >2 anastomoses; a subgroup of Extreme CRS patients (n = 10) had ≥5 organ resections and ≥3 anastomoses. Kaplan-Meier survival curves and multivariate Cox-regression models were used to identify prognostic factors affecting outcomes. Results: Relative to the comparison group, patients undergoing Extensive CRS had a higher median peritoneal carcinomatosis index, operative duration, blood loss, and length of stay. No difference in completeness of cytoreduction, severe morbidity, or 60-day mortality was evident. Subgroup analysis of 10 patients undergoing extreme CRS likewise revealed no increase in severe morbidity or mortality. Median progression-free (PFS) and overall survival (OS) were 23.5 and 74 months in the comparison group; 18.5 (p = 0.086) and 51 (p = 0.85) months in the Extensive CRS group; and 40 months and not reached in the Extreme CRS subgroup. In a multivariable analysis, extent of CRS was not independently associated with PFS or OS. Conclusions: Extensive CRS is associated with greater OR time, blood loss, and length of stay, but is not associated with higher morbidity, mortality, or inferior oncologic outcomes in patients with appendiceal carcinomatosis.

AB - Background: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemoperfusion (HIPEC) are frequently used to treat appendiceal carcinomatosis. Some patients require multivisceral resection because of the volume of disease. It is unclear whether extent of CRS impacts survival in appendiceal carcinomatosis. Methods: We analyzed 282 patients undergoing attempted CRS/HIPEC for appendiceal carcinomatosis. Patients were defined as having undergone Extensive CRS (n = 60) if they had >3 organ resections or >2 anastomoses; a subgroup of Extreme CRS patients (n = 10) had ≥5 organ resections and ≥3 anastomoses. Kaplan-Meier survival curves and multivariate Cox-regression models were used to identify prognostic factors affecting outcomes. Results: Relative to the comparison group, patients undergoing Extensive CRS had a higher median peritoneal carcinomatosis index, operative duration, blood loss, and length of stay. No difference in completeness of cytoreduction, severe morbidity, or 60-day mortality was evident. Subgroup analysis of 10 patients undergoing extreme CRS likewise revealed no increase in severe morbidity or mortality. Median progression-free (PFS) and overall survival (OS) were 23.5 and 74 months in the comparison group; 18.5 (p = 0.086) and 51 (p = 0.85) months in the Extensive CRS group; and 40 months and not reached in the Extreme CRS subgroup. In a multivariable analysis, extent of CRS was not independently associated with PFS or OS. Conclusions: Extensive CRS is associated with greater OR time, blood loss, and length of stay, but is not associated with higher morbidity, mortality, or inferior oncologic outcomes in patients with appendiceal carcinomatosis.

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