The Effect of Prior Nondefinitive Surgery on Perioperative Outcomes and Survival in Mucinous Appendix Cancer Patients Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy.
Sergei Iugai, Vadim Gushchin, Mary C King, Vladislav Kovalik, Kseniia Uzhegova, Luis F Falla-Zuniga, Carol Nieroda, Armando Sardi
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引用次数: 0
Abstract
Introduction: Peritoneal metastases (PM) from mucinous appendix cancer (MAC) are common and often mismanaged. While cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is standard, many patients undergo nondefinitive surgery. We compared outcomes in MAC patients undergoing CRS/HIPEC after limited vs excessive prior surgeries. Methods: We conducted a retrospective analysis of MAC patients (1998-2023) from a single-center prospective database who underwent CRS/HIPEC. Surgical history was evaluated using the prior surgical score (PSS). Perioperative characteristics were compared between PSS-0/1 and PSS-2/3 groups. Logistic regression identified factors associated with extensive prior surgery. Overall survival (OS) was analyzed with Kaplan-Meier and Cox regression. Results: Of 351 eligible cases, 221 (63%) had PSS-0/1 and 130 (37%) had PSS-2/3. Most individuals with PSS-2/3 were women (89.2%, n = 116). Only female sex was significantly associated with the higher likelihood of PSS-2/3 (odds ratio: 9.02, P < .001). PSS-2/3 patients had longer time from diagnosis to CRS/HIPEC (P < .001), longer CRS/HIPEC procedure (P = .007), and greater blood loss (P = .038). Complete cytoreduction (CC) rates were similar (P = .227). Despite comparable major complication rates, PSS-2/3 patients had more transfusions (P = .016), infections (P = .048), and pulmonary complications (P = .028). Five-year OS was 76% and 66% for PSS-0/1 and PSS-2/3 groups, respectively (P = .049). After adjusting for age, tumor burden, CC-score, and histology, PSS-2/3 was not significantly associated with shorter OS (hazard ratio: 1.32; P = .139). Conclusion: Females with MAC are more likely to have extensive surgeries, delaying CRS/HIPEC and compromising safety. This highlights the importance of general surgeons and gynecologists limiting the surgical extent and referring patients to an HIPEC center.
期刊介绍：
The American Surgeon is a monthly peer-reviewed publication published by the Southeastern Surgical Congress. Its area of concentration is clinical general surgery, as defined by the content areas of the American Board of Surgery: alimentary tract (including bariatric surgery), abdomen and its contents, breast, skin and soft tissue, endocrine system, solid organ transplantation, pediatric surgery, surgical critical care, surgical oncology (including head and neck surgery), trauma and emergency surgery, and vascular surgery.
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