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Hyperthermic Intraperitoneal Chemotherapy with Oxaliplatin for Peritoneal Carcinomatosis Arising from Appendix: Preliminary Results of a Survival Analysis

¹ Division of General Surgical Oncology, Department of Surgery, Hôpital Maisonneuve-Rosemont, Université de Montréal, 5415 Boul. de l’Assomption, Montréal, QC, Canada H1T 2M4
² Department of Anesthesiology, Hopital Maisonneuve-Rosemont, Université de Montréal, Montréal, QC, Canada
³ Department of Pathology, Hopital Maisonneuve-Rosemont, Université de Montréal, Montréal, QC, Canada
⁴ Department of Pharmacy, Hopital Maisonneuve-Rosemont, Université de Montréal, Montréal, QC, Canada

Correspondence: Address correspondence and reprint requests to: Lucas Sideris, MD, FRCSC; E-mail: sideris8{at}sympatico.ca

Background: Peritoneal carcinomatosis (PC) arising from the appendix is a rare disease for which the long-term prognosis is poor. The aim of this study was to evaluate the results of an aggressive approach used in our institution over the last 5 years.

Methods: Data from all patients with PC arising from the appendix were prospectively collected and analyzed. Treatment consisted in complete surgical cytoreduction followed by hyperthermic intraperitoneal chemotherapy (HIPEC) with oxaliplatin (460 mg/m²) in 2 L/m² of D5W at 43°C during 30 min. Ronnett’s histologic classification was used for tumor grading.

Results: From February 2003 to March 2007, 38 patients with PC arising from the appendix underwent laparotomy with curative intent. Mean follow-up was 23 months. Twenty-three patients received HIPEC but ten patients could not have complete cytoreductive surgery and received no HIPEC. Five patients with a negative second-look surgery also received no HIPEC. Three-year overall survival (OS) was 100% for the negative second-look patients, 86% for the HIPEC patients, and 29% for the unresectable patients (P = 0.0098). Three-year disease-free survival (DFS) was 49% for the HIPEC patients. Histologic grade was a prognostic factor with regard to DFS for the HIPEC patients (P = 0.011). There was one postoperative mortality. The overall major (grade III–V/V) complication rate for treated patients was 39%, including intra-abdominal abscess (22%), hemorrhage (18%), and anastomotic leak (9%).

Conclusion: Although these results are preliminary, this therapeutic approach seems both feasible and safe in selected patients.

Key Words: Peritoneal neoplasms • Appendiceal neoplasms • Hyperthermic intraperitoneal chemotherapy • Oxaliplatin