Prophylactic cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for low-grade appendiceal mucinous tumors with early and limited disease after completely removed

Abstract

Abstract Background The necessity of prophylactic cytoreductive surgery (PCRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for low-grade appendiceal mucinous neoplasms (LAMN) after complete removal is still controversial. This study aims to determine the role of PCRS + HIPEC and identify optimal strategies for managing these patients. Methods One hundred and fifty-nine patients who sought medical advice at Aerospace Center Hospital were retrospectively analyzed from January 2011 to December 2021. All the patients were divided into the PCRS group and the observation group. The data of surgical specimens and pathology was collected, and the effect on recurrence-free survival (RFS) was analyzed. Results Of these 159 patients, 88 were in the PCRS group, and 71 were in the observation group. The median follow-up time was 38 months. Seven patients recurred and developed into pseudomyxoma peritonei, one in the PCRS group and six in the observation group. The median RFS in the PCRS group was significantly longer than the observation group (48.0 vs. 36.0, p = 0.002). The analysis of RFS showed that patients who underwent PCRS (p = 0.009 ) and HIPEC (p = 0.007) had better survival. After multivariate analysis, Surgical specimen accompanied by disseminated peritoneal adenocarcinoma was identified as an independent prognostic factor for RFS. In the study of surgical resection content, patients with greater omentum (p = 0.007) and bilateral fallopian tubes and ovaries of women (p = 0.002) resection had a more prolonged RFS with statistical significance. Conclusion Without higher-level evidence, PCRS and HIPEC are necessary for LAMN after complete removal in patients with a high risk of recurrence. We recommend removing at least the greater omentum and women's bilateral fallopian tubes and ovaries. For women who are unwilling to remove the bilateral fallopian tubes and ovaries, they should be fully informed of the risks.