Use of early postoperative intraperitoneal 5‐fluorouracil with index cytoreduction improves survival with secondary cytoreductive surgery

Abstract

AbstractBackgroundIn patients with appendiceal mucinous neoplasm with peritoneal dissemination, a cytoreductive surgery (CRS) with perioperative chemotherapy may result in long‐term survival. Disease progression may require secondary cytoreductive surgery (SCRS) and other treatments in selected patients to improve survival and preserve an optimal quality of life.MethodsThe clinical‐ and treatment‐related variables associated with the index CRS and SCRS were statistically assessed for impact on survival after SCRS.ResultsA total of 186 of 687 complete CRS patients (27.1%) had SCRS. Median follow‐up was 10 years and median survival was 12 years. In 95 males (51%) the median age was 45.0 years. Survival benefit with SCRS was observed if early postoperative intraperitoneal chemotherapy (EPIC) with 5‐fluorouracil (EPIC 5‐FU) or hyperthermic intraperitoneal chemotherapy (HIPEC) plus EPIC 5‐FU was used with the index CRS (hazard ratio [HR]: 0.6, p = 0.0360; HR: 0.4, p = 0.0004, respectively). By propensity matching of 51 pairs of patients, EPIC 5‐FU used with index CRS caused a survival advantage compared to HIPEC alone (p = 0.0100) with index CRS (p = 0.0100).ConclusionsUse of EPIC 5‐FU at a complete index CRS was a prognostic variable that improved survival in patients requiring SCRS. Further investigations into the benefits of antiadhesion treatments with CRS and HIPEC are warranted.