Survival benefits with EPIC in addition to HIPEC for low grade appendiceal neoplasms with pseudomyxoma peritonei: a propensity score matched study.

Raymond Hayler, Kathleen Lockhart, Shoma Barat, Ernest Cheng, Jasmine Mui, Raphael Shamavonian, Nima Ahmadi, Nayef Alzahrani, Winston Liauw, David Morris
Author Information
  1. Raymond Hayler: Peritonectomy and Liver Cancer Unit, Department of Surgery, St George Hospital, NSW, Sydney, Australia.
  2. Kathleen Lockhart: Peritonectomy and Liver Cancer Unit, Department of Surgery, St George Hospital, NSW, Sydney, Australia.
  3. Shoma Barat: Peritonectomy and Liver Cancer Unit, Department of Surgery, St George Hospital, NSW, Sydney, Australia. ORCID
  4. Ernest Cheng: Peritonectomy and Liver Cancer Unit, Department of Surgery, St George Hospital, NSW, Sydney, Australia.
  5. Jasmine Mui: Peritonectomy and Liver Cancer Unit, Department of Surgery, St George Hospital, NSW, Sydney, Australia.
  6. Raphael Shamavonian: Peritonectomy and Liver Cancer Unit, Department of Surgery, St George Hospital, NSW, Sydney, Australia.
  7. Nima Ahmadi: Peritonectomy and Liver Cancer Unit, Department of Surgery, St George Hospital, NSW, Sydney, Australia.
  8. Nayef Alzahrani: Peritonectomy and Liver Cancer Unit, Department of Surgery, St George Hospital, NSW, Sydney, Australia.
  9. Winston Liauw: School of Clinical Medicine, St George & Sutherland Campus, UNSW Medicine & Health, Sydney, Australia.
  10. David Morris: Peritonectomy and Liver Cancer Unit, Department of Surgery, St George Hospital, NSW, Sydney, Australia.

Abstract

Objectives: Appendiceal cancer is a rare malignancy, occurring in roughly 1.2 per 100,000 per year. Low grade appendiceal neoplasams (LAMN) in particular can lead to pseudomyxoma peritonei (PMP), and respond poorly to systemic chemotherapy. Standard treatment includes cytoreduction surgery (CRS) with addition of heated intraoperative peritoneal chemotherapy (HIPEC). Several centres include early postoperative intraperitoneal chemotherapy (EPIC) however; the literature is mixed on the benefits. We aim to examine the benefits of additional EPIC through a propensity-matched analysis.
Methods: Patients with LAMN with PMP who underwent cytoreductive surgery at St George hospital between 1996 and 2020 were included in this retrospective analysis. Propensity score matching was performed with the following used to identify matched controls; sex, age, American Society of Anesthesiologists (ASA) grade, peritoneal cancer index (PCI) and morbidity grade. Outcomes measured included length of stay and survival.
Results: A total of 224 patients were identified of which 52 received HIPEC alone. Propensity matching was performed to identify 52 matched patients who received HIPEC + EPIC. Those receiving HIPEC + EPIC were younger at 54.3 vs. 58.4 years (p=0.044). There was a median survival benefit of 34.3 months for HIPEC + EPIC (127.3 vs. 93.0 months, p=0.02). Median length of stay was higher in those who received EPIC (25.0 vs. 23.5 days, p=0.028).
Conclusions: In LAMN with PMP, the addition of EPIC to HIPEC with CRS improves overall survival in propensity score matched cases but results in prolonged hospitalisation. The use of EPIC should still be considered in selected patients.

Keywords

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Word Cloud

Created with Highcharts 10.0.0EPICchemotherapygradeHIPECmatchedsurvivalLAMNpseudomyxomaPMPsurgeryadditionbenefitsanalysisscorepatientsreceivedHIPEC + EPICvsp=0cancerperappendicealperitoneiCRSperitonealearlypostoperativeintraperitonealcytoreductiveincludedPropensitymatchingperformedidentifylengthstay523propensityObjectives:Appendicealraremalignancyoccurringroughly12100000yearLowneoplasamsparticularcanleadrespondpoorlysystemicStandardtreatmentincludescytoreductionheatedintraoperativeSeveralcentresincludehoweverliteraturemixedaimexamineadditionalpropensity-matchedMethods:PatientsunderwentStGeorgehospital19962020retrospectivefollowingusedcontrolssexageAmericanSocietyAnesthesiologistsASAindexPCImorbidityOutcomesmeasuredResults:total224identifiedalonereceivingyounger54584 years044medianbenefit343 months127930 months02Medianhigher250235 days028Conclusions:improvesoverallcasesresultsprolongedhospitalisationusestillconsideredselectedSurvivallowneoplasmsperitonei:studyintra-peritonealhyperthermic

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