ABSTRACT
INTRODUCTION: Early recurrence (ER) is defined as development of loco-regional peritoneal disease within 12-month of the initial CRS/PIC. Our aims were to identify overall survival (OS), recurrence-free survival (RFS) and independent prognostic factors associated with ER in PM of appendiceal neoplasm. MATERIALS AND METHODS: A prospectively-maintained database for patients with appendiceal neoplasm undergoing cytoreductive surgery (CRS) and perioperative intraperitoneal chemotherapy (PIC) from year 1996-2018 was retrospectively analysed. RESULTS: 208 female and 185 male patients were identified. With a median follow-up of 40-month, 40.2% of the patients developed ER. The median OS for ER was 24 months compared to late (LR) at 64 months. Median OS was not reached in non-recurrence (NR). 5-year survival for ER was less favourable compared to LR and NR (19.3%vs54.6%vs94%). No patients in ER group survived beyond 10-year. Independent negative predictors associated with ER on multivariate analysis were male patient (pâ¯=â¯0.013), blood transfusion of >8 units (pâ¯=â¯0.013), elevated preoperative CEA levels (>5â¯ng/ml; pâ¯=â¯0.002) and hard intraoperative tumour consistency (pâ¯<â¯0.001). Protective factor was a combination of CC1, hard tumour consistency and use of EPIC (pâ¯=â¯0.039). Independent prognostic factors that predicted recurrence of appendiceal PM were PCI >20 (pâ¯=â¯0.049), non-use of EPIC (pâ¯=â¯0.012), hard tumour consistency (pâ¯=â¯0.004) and use of previous chemotherapy (pâ¯=â¯0.023). CONCLUSION: ER following CRS and PIC of appendiceal PM is associated with reduced survival outcomes. Our data alludes to the importance of optimising the risk factors in order to delay loco-regional recurrence and improve long-term survival of these patients.
