Should We Be Doing Cytoreductive Surgery with HIPEC for Signet Ring Cell Appendiceal Adenocarcinoma? A Study from the US HIPEC Collaborative.

Published on Jan 1, 2020in Journal of Gastrointestinal Surgery2.686
· DOI :10.1007/s11605-019-04336-4
Nick C. Levinsky3
Estimated H-index: 3
(University of Cincinnati Academic Health Center),
Mackenzie C. Morris1
Estimated H-index: 1
(University of Cincinnati Academic Health Center)
+ 25 AuthorsSameer H. Patel14
Estimated H-index: 14
(University of Cincinnati Academic Health Center)
Background Appendiceal adenocarcinoma with signet ring cells (SCA) is associated with worse overall survival (OS), and it is unclear whether cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) should be pursued in this patient population. We assessed the prognostic implications of signet ring cells in patients with appendiceal adenocarcinoma and peritoneal carcinomatosis undergoing CRS-HIPEC.
  • References (24)
  • Citations (0)
#1D. Solomon (ISMMS: Icahn School of Medicine at Mount Sinai)H-Index: 2
#2Natasha DeNicola (ISMMS: Icahn School of Medicine at Mount Sinai)H-Index: 1
Last. Deepa Magge (ISMMS: Icahn School of Medicine at Mount Sinai)H-Index: 9
view all 9 authors...
3 CitationsSource
#1Konstantinos I. Votanopoulos (Wake Forest Baptist Medical Center)H-Index: 21
#2David Bartlett (University of Pittsburgh)H-Index: 18
Last. Edward A. Levine (Wake Forest Baptist Medical Center)H-Index: 54
view all 11 authors...
Background Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is a treatment option in patients with carcinomatosis from high-grade appendiceal (HGA) primaries. It is unknown if there is a Peritoneal Carcinomatosis Index (PCI) upper limit above which a complete CRS/HIPEC does not assure long-term survival.
9 CitationsSource
#1Travis E. Grotz (University of Texas MD Anderson Cancer Center)H-Index: 3
#2Richard E. RoyalH-Index: 34
Last. Keith F. FournierH-Index: 7
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Stratification of outcomes for mucinous appendiceal adenocarcinoma with peritoneal metastasis by histological grade
5 CitationsSource
#1Travis E. Grotz (University of Texas MD Anderson Cancer Center)H-Index: 3
#2Michael J. Overman (University of Texas MD Anderson Cancer Center)H-Index: 37
Last. Keith Francis Fournier (University of Texas MD Anderson Cancer Center)H-Index: 13
view all 13 authors...
Background Moderately and poorly differentiated adenocarcinoma of the appendix represents an aggressive histological variant with a high risk of recurrence and death.
5 CitationsSource
#1Riom KwakmanH-Index: 4
#2Anne M. SchramaH-Index: 1
Last. Elisabeth A. te VeldeH-Index: 6
view all 8 authors...
Abstract To improve patient selection for cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) by evaluating various preoperatively assessable clinicopathological parameters as markers for survival after CRS and HIPEC. Peritoneal metastases (PMs) originating from colorectal cancer are treated with CRS and HIPEC. Despite increasing survival, high morbidity and mortality warrant selection of patients with optimal benefit from this treatment. Many studies report a numbe...
38 CitationsSource
#1Chukwuemeka Ihemelandu (Washington Cancer Institute)H-Index: 4
#2Paul H. Sugarbaker (Washington Cancer Institute)H-Index: 83
Background Tumors that show a signet ring or adenocarcinoid histomorphology have been associated with a poor prognosis. This study aimed to analyze the clinicopathologic and prognostic features in patients with peritoneal metastasis from mucinous adenocarcinoma (PMCA), adenocarcinoma with signet ring cell (PMCA-S), or adenocarcinoid (PMCA-A) of the appendix treated with cytoreductive surgery and perioperative intraperitoneal chemotherapy.
20 CitationsSource
#1Rahul RajeevH-Index: 5
#2Brittany KloosterH-Index: 2
Last. Kiran K. Turaga (MCW: Medical College of Wisconsin)H-Index: 25
view all 3 authors...
Complex surgical operations performed at centers of high volume have improved outcomes due to improved surgical proficiency, and betters systems of care including avoidance of errors. Cytoreductive surgery (CRS) and hyperthermic intra-peritoneal chemoperfusion (HIPEC), which has been shown to be an oncologically effective strategy for peritoneal carcinomatosis (PC), is one such procedure with significant morbidity and mortality. The learning curve to reach technical proficiency in CRS + HIPEC is...
9 CitationsSource
Pseudomyxoma peritonei (PMP) is a complex disease with unique biological behavior that usually arises from appendiceal mucinous neoplasia. The classification of PMP and its primary appendiceal neoplasia is contentious, and an international modified Delphi consensus process was instigated to address
127 CitationsSource
#1Vladimir Milovanov (Mercy Medical Center (Baltimore, Maryland))H-Index: 4
#2Armando Sardi (Mercy Medical Center (Baltimore, Maryland))H-Index: 25
Last. Vadim Gushchin (Mercy Medical Center (Baltimore, Maryland))H-Index: 14
view all 8 authors...
Abstract Background The role of SC before CRS/HIPEC for patients with PMCA is unclear. This study explores the effect of SC prior to CRS/HIPEC on overall survival (OS) in patients with PMCA. Methods 72 patients with recently diagnosed PMCA who underwent CRS/HIPEC were identified from a prospective database. Thirty patients had SC before CRS/HIPEC (Group 1) and 42 did not (Group 2). Patients who were referred to our center after multiple lines of SC were excluded from this analysis. OS was estima...
9 CitationsSource
#2H.J. BraamH-Index: 10
Last. I.H.J.T. de HinghH-Index: 36
view all 7 authors...
Background: Signet ring cell cancer (SRCC) patients have a poor oncologic outcome. The aim of this study was to determine whether the potential drawbacks of hyperthermic intraperitoneal chemotherapy (HIPEC) outweigh the benefits in patients with peritoneally metastasized SRCC. Methods: Patients with peritoneal carcinomatosis (PC) of colorectal origin referred to two tertiary centers between April 2005 and December 2013 were identified and retrospectively analyzed. Data were compared between SRCC...
33 CitationsSource
Cited By0
#1JC Chen (The Ohio State University Wexner Medical Center)
#2Eliza W. Beal (The Ohio State University Wexner Medical Center)H-Index: 10
Last. Jordan M. Cloyd (The Ohio State University Wexner Medical Center)H-Index: 9
view all 6 authors...
BACKGROUND: Cytoreductive surgery (CRS) with or without hyperthermic intraperitoneal chemotherapy (HIPEC) is indicated for patients with peritoneal dissemination of appendiceal cancer. The role of neoadjuvant chemotherapy (NAC) before CRS-HIPEC remains controversial. METHODS: A retrospective review of adult patients who underwent CRS +/- HIPEC for metastatic appendiceal cancer between 2000-2017 was performed. Patients who received NAC followed by surgery were compared with those who underwent su...