(PM P7) Outcomes of Palliative CRS/HIPEC for Patients with Advanced Peritoneal Carcinomatosis from Appendiceal Cancer

Background: The impact of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemoperfusion (HIPEC) on the palliation of advanced peritoneal carcinomatosis (PC) from appendiceal cancer is unknown.

Methods: The US HIPEC Collaborative was retrospectively reviewed to compare the outcomes of patients with appendiceal cancer who underwent CRS/HIPEC. Patients were stratified by operative intent and completeness of cytoreduction (CC) into three categories: curative (curative intent and CC 0/1 resection), incomplete (curative intent and CC 2/3 resection), and palliative (palliative intent and CC 2/3 resection).

Results: CRS/HIPEC was performed in 1,311 patients with PC of appendiceal origin: 1,086 (83%) curative; 182 (14%) incomplete; 43 (3%) palliative. Mean age was 55 years and 58% were female. Peritoneal Cancer Index correlated with CC score and operative designation (curative13.9 vs. incomplete 24.5 vs. palliative 31.9, p<0.0001; Table 1). Length of surgery was significantly longer for curative CRS/HIPEC (7.7 vs. 6.5 vs. 6.5 hours, p<0.0001). There were no significant differences in hospital length of stay (11.9 vs. 12.4 vs. 12.2 days), 30-day complications (57% vs 56% vs 53%, p=0.89) or readmissions (18% vs. 15% vs. 19%, p=0.62). Median survival after palliative CRS/HIPEC was 2.5 years. After palliative CRS/HIPEC, 80% experienced partial/complete resolution of ascites symptoms, 100% partial/complete improvement in obstructive symptoms, and 90% had improvement in pain symptoms.

Conclusion: Palliative intent CRS/HIPEC provides high rates of symptom control and acceptable survival in patients with advanced appendiceal PC. Appropriate patient selection is essential and efforts should be made to improve operative times, length of stay and minimize complications.