Prospective morbidity and mortality assessment of cytoreductive surgery plus perioperative intraperitoneal chemotherapy to treat peritoneal dissemination of appendiceal mucinous malignancy

Paul H. Sugarbaker, Robert Alderman, Gary Edwards, Christina Ellen Marquardt, Vadim Gushchin, Jesus Esquivel, David Chang

Research output: Contribution to journalArticle

Abstract

Background: Appendiceal mutinous neoplasms present, in most patients, with peritoneal dissemination at the time of initial diagnosis. Patients may have a borderline tumor showing disseminated peritoneal adenomucinosis or an aggressive malignancy identified as peritoneal mutinous adenocarcinoma. Patients with these diagnoses were treated by cytoreductive surgery and perioperative intraperitoneal chemotherapy. Methods: A database was established in 1998 that prospectively evaluated the morbidity and mortality of this group of patients. By using common toxicity grading criteria, 8 categories were scored on a grade of I to V. Grade IV indicated that the adverse event required urgent and definitive intervention: often a return to the operating room or to the surgical intensive care unit. Grade V indicated that the adverse events resulted in the patient's death. Adverse events were tabulated for each cytoreduction performed in these appendiceal malignancy patients. Results: There were 356 procedures in patients taken to the operating room who received cytoreductive surgery with peritonectomy procedures plus heated intraoperative intraperitoneal chemotherapy. Only patients who had this combined treatment at our institution were included in the analysis. The total 30-day or in-hospital mortality was 2.0%. Nineteen percent of procedures were accompanied by at least one grade IV adverse event, and 11.1% of patients returned to the operating room. The most common category of grade IV complications was hematological (28%), followed by gastrointestinal (26%). Conclusions: The mortality of 2.0% and the overall grade IV morbidity of 19% in these patients may be acceptable in light of modern standards for the management of gastrointestinal cancer.

Original languageEnglish (US)
Pages (from-to)635-644
Number of pages10
JournalAnnals of Surgical Oncology
Volume13
Issue number5
DOIs
StatePublished - May 2006
Externally publishedYes

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Morbidity
Drug Therapy
Mortality
Neoplasms
Operating Rooms
Appendiceal Neoplasms
Gastrointestinal Neoplasms
Critical Care
Hospital Mortality
Intensive Care Units
Adenocarcinoma
Databases

Keywords

  • 5-Fluorouracil
  • Cytoreductive surgery
  • Hyperthermia
  • Intraperitoneal chemotherapy
  • Mitomycin C
  • Peritonectomy

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Prospective morbidity and mortality assessment of cytoreductive surgery plus perioperative intraperitoneal chemotherapy to treat peritoneal dissemination of appendiceal mucinous malignancy. / Sugarbaker, Paul H.; Alderman, Robert; Edwards, Gary; Marquardt, Christina Ellen; Gushchin, Vadim; Esquivel, Jesus; Chang, David.

In: Annals of Surgical Oncology, Vol. 13, No. 5, 05.2006, p. 635-644.

Research output: Contribution to journalArticle

Sugarbaker, Paul H. ; Alderman, Robert ; Edwards, Gary ; Marquardt, Christina Ellen ; Gushchin, Vadim ; Esquivel, Jesus ; Chang, David. / Prospective morbidity and mortality assessment of cytoreductive surgery plus perioperative intraperitoneal chemotherapy to treat peritoneal dissemination of appendiceal mucinous malignancy. In: Annals of Surgical Oncology. 2006 ; Vol. 13, No. 5. pp. 635-644.
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abstract = "Background: Appendiceal mutinous neoplasms present, in most patients, with peritoneal dissemination at the time of initial diagnosis. Patients may have a borderline tumor showing disseminated peritoneal adenomucinosis or an aggressive malignancy identified as peritoneal mutinous adenocarcinoma. Patients with these diagnoses were treated by cytoreductive surgery and perioperative intraperitoneal chemotherapy. Methods: A database was established in 1998 that prospectively evaluated the morbidity and mortality of this group of patients. By using common toxicity grading criteria, 8 categories were scored on a grade of I to V. Grade IV indicated that the adverse event required urgent and definitive intervention: often a return to the operating room or to the surgical intensive care unit. Grade V indicated that the adverse events resulted in the patient's death. Adverse events were tabulated for each cytoreduction performed in these appendiceal malignancy patients. Results: There were 356 procedures in patients taken to the operating room who received cytoreductive surgery with peritonectomy procedures plus heated intraoperative intraperitoneal chemotherapy. Only patients who had this combined treatment at our institution were included in the analysis. The total 30-day or in-hospital mortality was 2.0{\%}. Nineteen percent of procedures were accompanied by at least one grade IV adverse event, and 11.1{\%} of patients returned to the operating room. The most common category of grade IV complications was hematological (28{\%}), followed by gastrointestinal (26{\%}). Conclusions: The mortality of 2.0{\%} and the overall grade IV morbidity of 19{\%} in these patients may be acceptable in light of modern standards for the management of gastrointestinal cancer.",
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AU - Esquivel, Jesus

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AB - Background: Appendiceal mutinous neoplasms present, in most patients, with peritoneal dissemination at the time of initial diagnosis. Patients may have a borderline tumor showing disseminated peritoneal adenomucinosis or an aggressive malignancy identified as peritoneal mutinous adenocarcinoma. Patients with these diagnoses were treated by cytoreductive surgery and perioperative intraperitoneal chemotherapy. Methods: A database was established in 1998 that prospectively evaluated the morbidity and mortality of this group of patients. By using common toxicity grading criteria, 8 categories were scored on a grade of I to V. Grade IV indicated that the adverse event required urgent and definitive intervention: often a return to the operating room or to the surgical intensive care unit. Grade V indicated that the adverse events resulted in the patient's death. Adverse events were tabulated for each cytoreduction performed in these appendiceal malignancy patients. Results: There were 356 procedures in patients taken to the operating room who received cytoreductive surgery with peritonectomy procedures plus heated intraoperative intraperitoneal chemotherapy. Only patients who had this combined treatment at our institution were included in the analysis. The total 30-day or in-hospital mortality was 2.0%. Nineteen percent of procedures were accompanied by at least one grade IV adverse event, and 11.1% of patients returned to the operating room. The most common category of grade IV complications was hematological (28%), followed by gastrointestinal (26%). Conclusions: The mortality of 2.0% and the overall grade IV morbidity of 19% in these patients may be acceptable in light of modern standards for the management of gastrointestinal cancer.

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