Repeat cytoreduction and hyperthermic intraperitoneal chemotherapy for recurrent peritoneal carcinomatosis of appendiceal origin.
BACKGROUND
The purpose of this study was to clarify the role of repeat cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) in the management of recurrent peritoneal carcinomatosis of appendiceal origin.


METHODS
Data were retrieved on 42 patients who underwent CRS + HIPEC; 29 repeat surgical procedures were performed in 13 patients.


RESULTS
Complete cytoreduction was achieved in 12 of 13 patients by the second CRS. Repeat recurrence was detected in 11 patients, eight of whom underwent a third CRS. The peritoneal cancer index decreased from initial CRS to repeat CRS but was still higher than 18 in nine patients at the second CRS. Preoperative chemotherapy was given to three patients with early recurrence. Grade 3-5 morbidity and 90-day mortality were not significantly different between initial and repeat CRS. Five-year survival rates after first and second CRS were 75.5 and 67.7%, respectively. Complete cytoreduction at second CRS was a significant prognostic factor. Among patients with recurrence after the second CRS, patients who underwent a third CRS showed a better prognosis than those who did not.


CONCLUSIONS
Repeat CRS is oncologically beneficial, and the morbidity rate was as high as that of initial CRS. Complete cytoreduction was the key to successful long-term results. Although further recurrence was common, aggressive resection was useful, even in cases of diffuse recurrence.
['Kitai|Toshiyuki|T|http://orcid.org/0000-0001-7096-7450', 'Yamanaka|Kenya|K|']
D000328:Adult D000368:Aged D001063:Appendiceal Neoplasms D014408:Biomarkers, Tumor D065426:Cytoreduction Surgical Procedures D005260:Female D006801:Humans D006979:Hyperthermia, Induced D008297:Male D008875:Middle Aged D009364:Neoplasm Recurrence, Local D010534:Peritoneal Neoplasms D011379:Prognosis D012189:Retrospective Studies D015996:Survival Rate
Repeat cytoreductive surgery Diffuse recurrence Appendiceal cancer Multidisciplinary approach Small intestine Third procedure