Narasimhan Vignesh, Pham Toan, Warrier Satish, Craig Lynch A, Michael Michael, Tie Jeanne, Ramsay Robert, Heriot Alexander
Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia.
ANZ J Surg. 2019 Sep;89(9):1035-1040. doi: 10.1111/ans.14985. Epub 2019 Jan 26.
Appendiceal epithelial neoplasms are rare cancers. Management of peritoneal disease from appendiceal neoplasms has historically been with debulking surgery. In recent decades, the advent of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has become the standard of care. Here, we report our single institution 10-year experience with CRS and HIPEC for appendiceal neoplasms.
This is a retrospective review from 1 January 2008 to 1 June 2017 of all patients undergoing CRS and HIPEC for appendiceal neoplasms. Institutional ethics approval was granted for this project.
One hundred and seventy-two patients underwent 208 CRSs during this time. Overall, 83.72% of patients had one CRS and HIPEC procedure. Pseudomyxoma peritonei from a perforated appendiceal mucinous neoplasm accounted for 67.9% of cases. The median peritoneal carcinomatosis index (PCI) was 14, with complete cytoreduction achieved in 74.2% of patients. Fifty-four percent of patients had at least one complication, with one (0.5%) peri-operative mortality in our cohort. For the entire cohort, the median overall survival was 104 months and a 5-year survival of 75%. In those having a complete cytoreduction, 5-year survival was 90%, with a median disease free interval of 63 months. PCI and completeness of cytoreduction were independent predictors of overall survival.
Our results demonstrate that CRS and HIPEC for appendiceal neoplasms are safe and effective. Despite carrying some morbidity, it offers patients an excellent disease free and overall survival.
阑尾上皮性肿瘤是罕见的癌症。阑尾肿瘤腹膜疾病的治疗历来采用减瘤手术。近几十年来，细胞减灭术（CRS）和腹腔内热灌注化疗（HIPEC）已成为标准治疗方法。在此，我们报告我们单机构10年来应用CRS和HIPEC治疗阑尾肿瘤的经验。
这是一项对2008年1月1日至2017年6月1日期间所有接受CRS和HIPEC治疗阑尾肿瘤患者的回顾性研究。该项目获得了机构伦理批准。
在此期间，172例患者接受了208次CRS。总体而言，83.72%的患者接受了一次CRS和HIPEC手术。阑尾黏液性肿瘤穿孔导致的腹膜假黏液瘤占病例的67.9%。腹膜癌指数（PCI）中位数为14，74.2%的患者实现了完全细胞减灭。54%的患者至少发生一种并发症，我们队列中有1例（0.5%）围手术期死亡。对于整个队列，中位总生存期为104个月，5年生存率为75%。在实现完全细胞减灭的患者中，5年生存率为90%，无病间隔中位数为63个月。PCI和细胞减灭的完整性是总生存期的独立预测因素。
我们的结果表明，CRS和HIPEC治疗阑尾肿瘤是安全有效的。尽管有一些发病率，但它为患者提供了良好的无病生存期和总生存期。
