Prophylactic hyperthermic intraperitoneal chemotherapy in patients with epithelial appendiceal neoplasms

Figures & data

Figure 1. Pathological examination from the initial appendectomy performed in a 60-year-old woman, demonstrating mucinous adenocarcinoma with invasion of the appendiceal wall by gland-forming malignant cells and dissecting mucin (haematoxylin and eosin, original magnification ×40).

Figure 2. A computed tomography scan (coronal view) of a 63-year-old man who presented with signs and symptoms of acute appendicitis. The scan showed distended appendix (arrow). The patient underwent emergent appendectomy and pathological exam diagnosed mucinous appendiceal adenocarcinoma.

Figure 3. Laparoscopic administration of prophylactic hyperthermic intraperitoneal chemotherapy. The periumbilical incision was used for extraction of resected omentum/colon.

Table 1. Baseline characteristics of 16 patients with epithelial appendiceal neoplasms who underwent prophylactic HIPEC procedures.

Characteristics	N = 16
Male gender, n (%)	9 (56.2)
Age (years), median (range)	54 (28–78)
Primary diagnosis, n (%)
Mucinous appendiceal adenocarcinoma	7 (43.7)
Goblet cell carcinoid	4 (25.0)
LAMN	5 (31.3)
Initial surgery, n (%)
Appendectomy	12 (75.0)
Right colectomy	4 (25.0)
Indication for prophylactic HIPEC, n (%)
Perforated tumour	13 (81.2)
pT3/4NxM0 high grade tumour	3 (18.8)
ASA score, median (range)	3 (2–4)

HIPEC, hyperthermic intraperitoneal chemotherapy; LAMN, low-grade appendiceal mucinous neoplasm; ASA, American Society of Anesthesiologists.

Table 2. Intraoperative and postoperative characteristics of patients with appendiceal neoplasms who underwent prophylactic HIPEC procedures.

	Entire cohort (n = 16)	Laparoscopic approach (n = 11)	Open approach (n = 5)
Diagnosis: tumour grade, n
Low-grade	5	2	3
High-grade	11	9	2
Additional organs resected, n
Omentum	14	9	5
Right colon	7	6	1
Ovaries	2	1	1
Duration of surgery* (min), median (range)	235 (174–310)	251 (192–310)	203 (174–237)
Estimated blood loss (mL), median (range)	100 (30–200)	100 (50–200)	50 (30–200)
Length of hospital stay (days), median (range)	4 (2–10)	4 (2–10)	4 (3–10)
Minor morbidity (grade < III), n	4	3	1
Major morbidity (grade ≥ III), n	–	–	–

HIPEC, hyperthermic intraperitoneal chemotherapy.

*Including 90-min perfusion of HIPEC.