How Prior Surgeries Affect Outcomes in Mucinous Appendix Cancer Patients Undergoing CRS/HIPEC
- PFCCAP Admin
- Feb 28
- 3 min read
Sergei Iugai MD, Mary Caitlin King BS, Vladislav Kovalik MD MPSH, Luis Felipe Falla-Zuniga MD, Kseniia Uzhegova MD, Abeerah Wasti BS, Carol Nieroda MD, Vadim Gushchin MD FACS, Armando Sardi MD FACS
Recipient: Golf Medal Research Project, 2025 Southeastern Surgical Congress
Dr. Sergei Iugai of Mercy Medical Center gave an oral presentation on The Effect of Prior Non-Definitive Surgery on Perioperative Outcomes and Survival in Mucinous Appendix Cancer Patients Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy at the 2025 Southeastern Surgical Congress in New Orleans, LA. He presented findings that emphasize the crucial role general surgeons and gynecologists play in optimizing patient outcomes by limiting the extent of surgery and ensuring early referral to HIPEC centers.
Mucinous appendix cancer is a rare disease that is often mistaken for other conditions. Because of this, many patients first undergo major surgeries by general surgeons or gynecologists that do not fully treat the cancer. These surgeries can make the best treatment—Cytoreductive Surgery with HIPEC (CRS/HIPEC)—more difficult due to scar tissue, changes in anatomy, and the spread of cancer cells.
In this study, researchers looked at 527 patients and compared those who had multiple major surgeries before CRS/HIPEC to those who only had minor or diagnostic procedures. They found that 37% of patients had undergone extensive surgeries before getting the right treatment. These patients faced longer wait times for CRS/HIPEC, longer and more complex surgeries, greater blood loss, and a higher risk of complications like severe anemia, infections, lung issues, and the need for IV nutrition. Women were especially likely to go through multiple surgeries before being referred to a specialist.
This study highlights the importance of early and correct referrals. General surgeons and gynecologists play a critical role in helping patients get to a HIPEC specialist as soon as possible, avoiding unnecessary surgeries that could make treatment more difficult.
A summary of the findings are provided below.
Background
Mucinous appendix cancer (MAC) is rare and often misdiagnosed. Although cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is an established standard of care for MAC, many patients undergo non-definitive surgery performed by general surgeons and gynecologists. This study aimed to explore the differences between MAC patients undergoing CRS/HIPEC after limited vs excessive prior surgical interventions.
Who Participated
The researchers looked at past medical records from a single cancer center, covering patients treated between 1998 and 2023. They focused on people with stage IV mucinous appendix cancer (MAC) who had their first treatment with CRS/HIPEC (the specialized surgery and heated chemotherapy).
Some patients were left out of the study, such as those with a different type of tumor (goblet cell tumors) or those who received HIPEC for symptom relief rather than as a curative treatment.
To understand how previous surgeries affected outcomes, the researchers categorized patients based on their surgical history:
PSS-0/1: Patients who had only a biopsy or minimal surgery before CRS/HIPEC.
PSS-2/3: Patients who had extensive surgery before CRS/HIPEC.
They then compared various patient characteristics, like how long they waited for CRS/HIPEC, how complex their surgeries were, and their survival rates. Advanced statistical methods were used to identify factors linked to extensive prior surgery and to analyze how it influenced long-term survival.
Key Findings
Women were far more likely to have undergone extensive prior surgeries before being referred for CRS/HIPEC.
Patients who had extensive prior surgery experienced longer wait times before getting the correct treatment, longer and more complicated CRS/HIPEC surgeries, and a higher risk of infections and lung complications after surgery.
However, the ability to remove all visible cancer during CRS/HIPEC was similar between groups.
Patients with extensive prior surgery had slightly lower survival rates at 5 years (66% vs. 76%), but after adjusting for other factors, prior surgery was not a strong predictor of survival.
Conclusion
Female patients with MAC are more likely to have extensive surgical histories before receiving definitive treatment. Non-definitive surgeries delay CRS/HIPEC and negatively affect its safety. This underscores the importance of general surgeons and gynecologists limiting the extent of surgery and referring patients to a HIPEC center.