Aziz, Omer

Barriuso, Jorge

Braun, Michael

Chakrabarty, Bipasha

Mullamitha, Saifee

Nagaraju, Raghavendar

O’Dwyer, Sarah T.

Strach, Madeleine

BackgroundAppendix adenocarcinomas (AA) are rare tumours that often present late, with a propensity for peritoneal metastases (PM). This study aimed to evaluate outcomes of AA patients undergoing cytoreductive surgery (CRS) with curative intent and determine the role of systemic chemotherapy.MethodsData were collected from a prospective database and classified according to WHO 2019. Tumour clearance from CRS was described using a completeness of cytoreduction (CC) score ranging from 0 (no residual disease, RD) to 3 (&gt;2.5 cm RD). Patients with CC0-2 CRS received hyperthermic intraperitoneal chemotherapy (HIPEC). Systemic chemotherapy was categorised as ‘prior’ (&gt;6 months before), ‘neoadjuvant’ (&lt;6 months before), ‘adjuvant’ (&lt;6 months after CC0-1 CRS), or ‘palliative’ (after CC2-3 CRS). Analyses used Kaplan-Meier and Cox regression methods.ResultsBetween January 2005 and August 2021, 216 AA patients were identified for inclusion. Median age was 59 years (21-81). CRS/HIPEC was performed in 182 (84%) patients, of whom 164/182 (76%) had Mitomycin C HIPEC). CC0-1 was achieved in 172 (80%). Systemic chemotherapy was given to 97 (45%) patients from the whole cohort and to 37/46 (80%) of patients with positive nodes. Median overall survival (OS) was 122 months (95% confidence interval, CI, 61-182 months). After multivariate analysis, patients with acellular and lower grade PM had similar OS to those with localised (M0) disease (p=0.59 and p=0.19). For patients with positive nodes, systemic chemotherapy was associated with reduced risk of death compared to no chemotherapy (p&lt;0.0019). ConclusionThis study identifies positive node status AA patients derive the most benefit from systemic chemotherapy. We confirm the prognostic importance of stage and peritoneal grade, with excellent outcomes in patients with AM and lower grade PM. <br/

The University of Manchester - Institutional Repository

Defining a role for systemic chemotherapy in local and advanced appendix adenocarcinomaa

Defining a role for systemic chemotherapy in local and advanced appendix adenocarcinomaa

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The University of Manchester - Institutional Repository