En Bloc Resection in Peritoneal Carcinomatosis with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Appendiceal Cancer: Surgical Strategies, Oncologic Outcomes, and Epidemiological Insights
Main Article Content
Abstract
Appendiceal cancer with peritoneal carcinomatosis (PC) represents a complex oncologic condition with distinct biological behavior and therapeutic challenges. Unlike other gastrointestinal malignancies, appendiceal neoplasms often exhibit extensive peritoneal dissemination, particularly in mucinous subtypes such as low-grade appendiceal mucinous neoplasms (LAMN) and pseudomyxoma peritonei (PMP). Historically, peritoneal dissemination was associated with poor prognosis, but the advent of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has dramatically altered the disease trajectory. En bloc resection has emerged as a critical surgical strategy to achieve complete cytoreduction (CC-0/1) in cases with extensive peritoneal involvement, preventing tumor fragmentation and reducing recurrence risk.
Epidemiologically, appendiceal neoplasms are rare, with an incidence of approximately 0.12 cases per 100,000 individuals per year, accounting for less than 1% of all gastrointestinal malignancies. Despite their low incidence, the diagnosis of appendiceal cancer has been increasing due to advancements in imaging modalities and more frequent incidental discoveries during appendectomies. The prognosis of appendiceal cancer varies widely depending on histologic subtype, peritoneal carcinomatosis index (PCI), and the feasibility of complete cytoreduction. This article explores the epidemiology, surgical principles, and oncologic outcomes of en bloc resection in conjunction with HIPEC, emphasizing patient selection criteria, operative techniques, and perioperative management. Additionally, we analyze the impact of histopathological subtypes on treatment response, recurrence patterns, and survival outcomes, providing a comprehensive overview of this aggressive but potentially curative approach to managing peritoneal carcinomatosis from appendiceal malignancies.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
I. Wang TY, Chen CY, Lu CH, et al. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for peritoneal malignancy: preliminary results of a multi-disciplinary teamwork model in Asia. Int J Hyperthermia 2018;34:328-35.
II. van Driel WJ, Koole SN, Sikorska K, et al. Hyperthermic Intraperitoneal Chemotherapy in Ovarian Cancer. N Engl J Med 2018;378:230-40.
III. Panarelli NC, Yantiss KR. Mucinous Neoplasms of the Appendix and Peritoneum. Arch Pathol Lab Med 2011;135:1261-8.
IV. Shankar S, Ledakis P, El Halabi H, et al. Neoplasms of the appendix: current treatment guidelines. Hematol Oncol Clin North Am 2012;26:1261-90.
V. Bruin SC, Verwaal VJ, Vincent A, et al. A clinicopathologic analysis of peritoneal metastases of colorectal and appendiceal origin. Ann Surg Oncol 2010;17:2330-40.
VI. American Joint Committee on Cancer. Colon and Rectum Cancer Staging. Available online: https://cancerstaging.org/referencestools/quickreferences/Documents/ColonMedium.pdf
VII. Washington K. 7th edition of the AJCC cancer staging manual: stomach. Ann Surg Oncol 2010;17:3077-9.
VIII. World Health Organization. Classification TNM/FIGO. Available online: http://screening.iarc.fr/atlasclassiftnm.php?lang=1
IX. U.S. Department of Health and Human Services. Common Terminology Criteria for Adverse Events (CTCAE). 2009. Available online: https://evs.nci.nih.gov/ftp1/CTCAE/CTCAE_4.03_2010-06-14_QuickReference_5x7.pd
X. Coccolini F, Gheza F, Lotti M, et al. Peritoneal Carcinomatosis. World J Gastroenterol 2013;19:6979-94.
XI. Mohamed F, Moran BJ. Morbidity and Mortality With Cytoreductive Surgery and Intraperitoneal Chemotherapy: The Importance of a Learning Curve. Cancer J 2009;15:196-9.
XII. Moran B, Cecil T, Chandrakumaran K, et al. The results of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in 1200 patients with peritoneal malignancy.Colorectal Dis 2015;17:772-8.
XIII. Coccolini F, Cotte E, Glehen O, et al. Intraperitoneal chemotherapy in advanced gastric cancer. Meta-analysis of randomized trials. Eur J Surg Oncol 2014;40:12-26.
XIV. Coccolini F, Catena F, Glehen O, et al. Complete versus incomplete cytoreduction in peritoneal carcinosis from gastric cancer, with consideration to PCI cut-off. Systematic review and meta-analysis. Eur J Surg Oncol 2015;41:911-9.
XV. Coccolini F, Catena F, Glehen O, et al. Effect of intraperitoneal chemotherapy and peritoneal lavage in positive peritoneal cytology in gastric cancer. Systematic review and meta-analysis. Eur J Surg Oncol 2016;42:1261-7.
XVI. Coccolini F, Celotti A, Ceresoli M, et al. Hyperthermic intraperitoneal chemotherapy (HIPEC) and neoadjuvant chemotherapy as prophylaxis of peritoneal carcinosis from advanced gastric cancer—effects on overall and disease free survival. J Gastrointest Oncol 2016;7:523-9.
XVII. Fugazzola P, Coccolini F, Montori G, et al. Overall and disease-free survival in patients treated with CRS + HIPEC with cisplatin and paclitaxel for gastric cancer with peritoneal carcinomatosis. J Gastrointest Oncol 2017;8:572-82.
XVIII. Mirnezami R, Mehta AM, Chandrakumaran K, et al. Cytoreductive surgery in combination with hyperthermic intraperitoneal chemotherapy improves survival in patients with colorectal peritoneal metastases compared with systemic chemotherapy alone. Br J Cancer 2014;111:1500-8.