Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA.
Department of Pathology, University of Chicago Medical Center, Chicago, IL, USA.
Ann Surg Oncol. 2021 Mar;28(3):1777-1785. doi: 10.1245/s10434-020-09064-7. Epub 2020 Sep 5.
Peritoneal metastases (PMs) from appendiceal ex-goblet adenocarcinoma (AEGA) are associated with a poor prognosis. While cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) has been shown to prolong survival, the majority of patients are ineligible for complete cytoreduction. We describe a novel approach to the management of such patients with iterative HIPEC (IHIPEC).
Patients with signet ring/poorly differentiated AEGA with high Peritoneal Cancer Index (PCI) and extensive bowel involvement underwent IHIPEC with mitomycin C at 6-week intervals for a total of three cycles. Survival outcomes for these patients were compared with patients with high-grade appendiceal tumors matched for tumor burden who were treated with other conventional approaches, i.e. systemic chemotherapy only (SCO) or complete CRS + HIPEC.
Between 2016 and 2019, seven AEGA patients with high PCI (median 32.5 [range 21-36]) underwent 18 IHIPEC cycles (median cycles per patient 3 [2-3]) in combination with systemic chemotherapy (median 2 lines [1-3], 12 cycles [10-28]). IHIPEC was delivered laparoscopically in 14/18 cases. Postoperatively, the median length of stay was 1 day (1-8 days), no procedure-related complications were reported, and five (28%) 90-day readmissions for bowel obstruction were documented. Median overall survival after IHIPEC was better compared with a matched group of patients (n = 16) receiving SCO (24.6 vs. 7.9 months; p = 0.005), and similar to those (n = 7) who underwent CRS + HIPEC (24.6 vs. 16.5 months; p = 0.62).
IHIPEC in combination with systemic chemotherapy is tolerable, safe, and may be associated with encouraging survival outcomes compared with SCO in selected patients with high-grade, high-burden AEGA PM.
阑尾 ex- 杯状细胞腺癌（AEGA）的腹膜转移（PMs）预后较差。虽然细胞减灭术（CRS）联合腹腔热灌注化疗（HIPEC）已被证明可延长生存时间，但大多数患者不符合完全细胞减灭术的条件。我们描述了一种治疗此类具有迭代 HIPEC（IHIPEC）的患者的新方法。
具有高腹膜癌症指数（PCI）和广泛肠受累的印戒细胞/低分化 AEGA 患者，每 6 周接受一次米托蒽醌 HIPEC，共进行三个周期。这些患者的生存结果与接受其他常规治疗方法（即仅全身化疗[SCO]或完全 CRS+HIPEC）的高分级阑尾肿瘤患者相匹配。
2016 年至 2019 年，7 名 PCI 较高（中位数 32.5[范围 21-36]）的 AEGA 患者接受了 18 次 IHIPEC 循环（中位数每位患者 3 次[2-3]），同时接受全身化疗（中位数 2 线[1-3]，12 个周期[10-28]）。18 次 IHIPEC 中有 14 次是在腹腔镜下进行的。术后，中位住院时间为 1 天（1-8 天），没有报告与手术相关的并发症，有 5 例（28%）患者因肠梗阻在 90 天内再次入院。与接受 SCO（24.6 与 7.9 个月；p=0.005）的匹配患者组相比，接受 IHIPEC 后中位总生存期更好，与接受 CRS+HIPEC（24.6 与 16.5 个月；p=0.62）的患者相似。
在选择的高分级、高负荷 AEGA PM 患者中，与 SCO 相比，IHIPEC 联合全身化疗耐受性好、安全，并且可能与令人鼓舞的生存结果相关。
