Mehta Akash, Mittal Rohin, Chandrakumaran Kandiah, Carr Norman, Dayal Sanjeev, Mohamed Faheez, Moran Brendan, Cecil Tom
Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Hampshire Hospitals National Health Service Foundation Trust, Basingstoke, Hampshire, United Kingdom.
Dis Colon Rectum. 2017 Nov;60(11):1155-1161. doi: 10.1097/DCR.0000000000000869.
Right hemicolectomy is routinely recommended in patients with histologic findings of high-grade appendix tumors after appendicectomy. Undetected peritoneal disease may be encountered at surgery. In high-grade appendix tumors with disease detected radiologically, complete cytoreduction may not be possible and outcomes poor. For these reasons, we adopted a policy of prophylactic cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.
The purpose of this study was to quantify the rates of peritoneal and nodal metastatic disease in patients with high-grade appendix tumors without obvious metastatic disease and to report the long-term outcomes of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in these patients.
Data regarding peritoneal and nodal metastatic disease were extracted from surgical and histologic records.
The study was conducted at a high-volume tertiary referral center for peritoneal malignancy.
Patients referred with histologically high-grade appendix tumors at appendicectomy, without detectable metastatic spread, between January 1994 and September 2016 were included MAIN OUTCOME MEASURES:: A total of 62 patients with high-grade pathology at appendicectomy, without clinical or radiological peritoneal disease, underwent complete cytoreduction with hyperthermic intraperitoneal chemotherapy.
Thirty-five (57%) of 62 patients had peritoneal disease (median peritoneal cancer index 5 (range, 1-28)). Eleven (31%) of 35 had microscopic peritoneal disease. Overall, 23 (37%) of 62 had peritoneal disease beyond the confines of a standard right hemicolectomy. Nine (15%) of 62 had nodal involvement. Mean overall and disease-free survival were 110.9 (95% CI, 94.8-127.0 mo) and 102.1 months (95% CI, 84.3-119.9 mo), with 5-year overall and disease-free survival of 83.2% and 76.0%.
The retrospective nature limits the interpretation of these results.
Complete cytoreduction was achieved in all of the patients, with excellent long-term survival. The incidence of peritoneal spread (57%) compared with nodal involvement (15%) supports cytoreductive surgery and hyperthermic intraperitoneal chemotherapy as definitive treatment rather than prophylaxis in patients with high-grade appendix tumors, even without radiologically detectable disease. High-grade appendix tumors benefit from early aggressive operative management to deal with potential peritoneal and nodal spread and should be considered for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. See Video Abstract at http://links.lww.com/DCR/A360.
阑尾切除术后组织学检查发现高级别阑尾肿瘤的患者，通常建议行右半结肠切除术。手术中可能会遇到未被发现的腹膜疾病。对于影像学检查发现有疾病的高级别阑尾肿瘤，可能无法实现完全细胞减灭，预后较差。基于这些原因，我们采用了预防性细胞减灭术和腹腔内热化疗的策略。
本研究的目的是量化无明显转移疾病的高级别阑尾肿瘤患者的腹膜和淋巴结转移疾病发生率，并报告这些患者细胞减灭术和腹腔内热化疗的长期预后。
从手术和组织学记录中提取有关腹膜和淋巴结转移疾病的数据。
该研究在一家大容量的腹膜恶性肿瘤三级转诊中心进行。
纳入1994年1月至2016年9月期间阑尾切除术后组织学检查为高级别阑尾肿瘤、无可检测到的转移扩散的患者。主要观察指标：共有62例阑尾切除术后病理为高级别、无临床或影像学腹膜疾病的患者接受了完全细胞减灭术及腹腔内热化疗。
62例患者中有35例（57%）存在腹膜疾病（腹膜癌指数中位数为5（范围1 - 28））。35例中有11例（31%）为微小腹膜疾病。总体而言，62例中有23例（37%）存在超出标准右半结肠切除术范围的腹膜疾病。62例中有9例（15%）有淋巴结受累。平均总生存期和无病生存期分别为110.9个月（95%可信区间，94.8 - 127.0个月）和102.1个月（95%可信区间，84.3 - 119.9个月），5年总生存率和无病生存率分别为83.2%和76.0%。
回顾性研究性质限制了对这些结果的解读。
所有患者均实现了完全细胞减灭，长期生存率良好。腹膜转移发生率（57%）与淋巴结受累发生率（15%）相比，支持细胞减灭术和腹腔内热化疗作为高级别阑尾肿瘤患者的确定性治疗而非预防性治疗，即使没有影像学可检测到的疾病。高级别阑尾肿瘤受益于早期积极的手术治疗以应对潜在的腹膜和淋巴结转移，应考虑行细胞减灭术和腹腔内热化疗。见视频摘要：http://links.lww.com/DCR/A360 。
