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

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. One hundred 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. 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, 1 in the PCRS group and 6 in the observation group. The analysis of RFS showed that patients who underwent PCRS (P = .01) and HIPEC (P = .01) had better survival. After multivariate analysis, the 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 = .01) and bilateral fallopian tubes and ovaries of women (P = .002) resection had a more prolonged RFS with statistical significance. The research indicated that PCRS + HIPEC could prevent recurrence. Therefore this treatment were necessary for LAMN after complete removal in patients with a high risk of recurrence. However, it was not proven to be an independent factor for RFS, and a multicenter, prospective, randomized trial was need to definitively address the role of PCRS + HIPEC for LAMN after complete resection.