R. W. Randle1, K. F. Griffith1, K. R. Swett2, J. H. Stewart1, P. Shen1, E. A. Levine1, K. I. Votanopoulos1 1Wake Forest University Baptist Medical Center,Surgery,Winston-Salem, NORTH CAROLINA, USA 2Wake Forest University Baptist Medical Center,Biostatistics,Winston-Salem, NORTH CAROLINA, USA
Introduction: Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is an aggressive treatment for patients suffering with peritoneal carcinomatosis. It is commonly applied to low-grade mucinous tumors of the appendix disseminated throughout the peritoneal cavity, yet some high volume centers have extended this therapy to carcinomatosis from a variety of more aggressive primary malignancies. Therefore we decided to review our experience with CRS-HIPEC for patients with carcinomatosis from goblet cell neuroendocrine carcinomas.
Methods: Patients with carcinomatosis and final pathology confirming goblet cell features were identified in a prospectively maintained database of 1069 CRS-HIPEC procedures performed between 1991 and 2013. Patient demographics, disease characteristics, morbidity, mortality, and survival were reviewed.
Results: A total of 25 patients with goblet cell neuroendocrine carcinomatosis underwent CRS-HIPEC during the study period. Tumors originated in the appendix in 23 (92%) patients and in the colon in 2 (8%). Patients were generally young (mean age 53 years) and otherwise healthy (84% without comorbidities) with good performance status (92% ECOG 0 or 1). The mean number of visceral resections was 3.6, and complete cytoreduction of all macroscopic disease was accomplished in 36% prior to HIPEC. The 30-day major morbidity and mortality were 36% and 8%, respectively. Median overall survival for all patients was 16.5 months. In univariate analysis, significant predictors of decreased survival included worse performance status (hazard ration [HR] 2.2, 95% confidence interval [CI] 1.1–4.4, p=0.03) and nodal involvement (HR 9.6, 95% CI 1.2–73.8, p=0.03). Despite similar volume of peritoneal disease, patients with negative nodes had better survival than those with positive nodes (median overall survival 32.7 months vs. 9.9 months), respectively (p=0.01). While complete cytoreduction was associated with longer survival following CRS-HIPEC in all patients (R0/R1 median overall survival 28.5 months vs. R2 median overall survival 9.9 months, p=0.19) and in those with nodal disease (R0/R1 median overall survival 16.5 months vs. R2 median overall survival 8.5 months, p=0.07), neither observed difference reached statistical significance.
Conclusion: CRS-HIPEC may improve survival in patients with node negative goblet cell neuroendocrine carcinomatosis when a complete cytoreduction is achieved. Patients with disease not amenable to complete cytoreduction should not be offered CRS-HIPEC.