Skip to main content

Advertisement

SpringerLink
Log in

Lymph Node Metastasis in Epithelial Malignancies of the Appendix With Peritoneal Dissemination Does Not Reduce Survival in Patients Treated by Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy

  • Original Article
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Peritoneal dissemination of appendiceal malignancy combined with regional lymph node metastasis is an unusual combination of patterns of cancer dissemination.

Methods

A database of 501 appendiceal malignancy patients, all with documented peritoneal seeding, was used to identify 25 patients with involvement of the regional lymph nodes. All patients were uniformly treated with cytoreductive surgery plus perioperative intraperitoneal chemotherapy with mitomycin C and 5-fluorouracil. The clinical and pathologic features of the lymph node–positive patients were compared with those of the lymph node–negative patients. The effect of regional lymph node involvement on survival was determined. Within the group of lymph node–positive patients, clinical and pathologic features were tested for their effect on survival.

Results

When compared with patients with no apparent lymph node positivity, patients with positive lymph nodes were more likely to have an acute abdomen as the initial presentation (P < .001). The intestinal (nonmucinous) histological type was more common (P < .001), and the disseminated peritoneal adenomucinosis histology was less common (P < .001). Survival with the aggressive treatment strategy used in these patients was not different for lymph node–positive as compared with lymph node–negative patients (P = .15 by univariate and P = .38 by multivariate analysis).

Conclusions

Appendiceal malignancy with dissemination to the lymph nodes has a more acute onset and a more frequent nonmucinous histology. With aggressive treatment strategies, lymph node–positive patients did not show a statistically significantly diminished survival.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

FIG. 1
FIG. 2
FIG. 3

Similar content being viewed by others

References

  1. PH Sugarbaker BM Ronnett A Archer et al. (1997) ArticleTitlePseudomyxoma peritonei syndrome Adv Surg 30 233–80

    Google Scholar 

  2. B Sadeghi C Arvieux O Glehen et al. (2000) ArticleTitlePeritoneal carcinomatosis from non-gynecologic malignancies. Results of the EVOCAPE 1 multicentric prospective study Cancer 88 358–63 Occurrence Handle1:STN:280:DC%2BD3c7gvVOntg%3D%3D Occurrence Handle10640968

    CAS  PubMed  Google Scholar 

  3. DZJ Chu NP Lang C Thompson PK Osteen KC Westbrook (1989) ArticleTitlePeritoneal carcinomatosis in nongynecologic malignancy. A prospective study of prognostic factors Cancer 63 364–7 Occurrence Handle1:STN:280:DyaL1M%2FovFGnsQ%3D%3D Occurrence Handle2910444

    CAS  PubMed  Google Scholar 

  4. JR Hilsabeck ES Judd LB Wollner (1951) ArticleTitleCarcinoma of the vermiform appendix Surg Clin North Am 31 995–1011 Occurrence Handle1:STN:280:DyaG3M%2Fps1aktw%3D%3D Occurrence Handle14866725

    CAS  PubMed  Google Scholar 

  5. KT Hesketh (1963) ArticleTitleThe management of primary adenocarcinoma of the vermiform appendix Gut 4 158–68 Occurrence Handle1:STN:280:DyaF387ksF2gtg%3D%3D Occurrence Handle13954206

    CAS  PubMed  Google Scholar 

  6. M Wolff N Ahmed (1976) ArticleTitleEpithelial neoplasms of the vermiform appendix (exclusive of carcinoid) Cancer 37 2493–522 Occurrence Handle1:STN:280:DyaE287mtlShtQ%3D%3D Occurrence Handle1260730

    CAS  PubMed  Google Scholar 

  7. ONM Panton GA Bell DA Owen (1983) ArticleTitleAdenocarcinoma of the vermiform appendix: retrospective study and literature review Can J Surg 26 276–9 Occurrence Handle1:STN:280:DyaL3s3gs1amsQ%3D%3D Occurrence Handle6303543

    CAS  PubMed  Google Scholar 

  8. RW Gilhome DH Johnston J Clark J Kyle (1984) ArticleTitlePrimary adenocarcinoma of the appendix: report of a series of ten cases and a review of the literature Br J Surg 71 553–5 Occurrence Handle1:STN:280:DyaL2c3jt12mug%3D%3D Occurrence Handle6733432

    CAS  PubMed  Google Scholar 

  9. MG Schlatter TK McKone DJ Scholten BW Bonnel LL deKryger (1987) ArticleTitlePrimary appendiceal adenocarcinoma Am Surg 53 434–7 Occurrence Handle1:STN:280:DyaL2s3mvV2htg%3D%3D Occurrence Handle3605863

    CAS  PubMed  Google Scholar 

  10. CC Conte NJ Petrelli J Stulc L Herrera A Mittelman (1988) ArticleTitleAdenocarcinoma of the appendix Surg Gynecol Obstet 166 451–3 Occurrence Handle1:STN:280:DyaL1c3gsFWnsQ%3D%3D Occurrence Handle2452489

    CAS  PubMed  Google Scholar 

  11. SS Nitecki BG Wolff R Schlinkert MG Sarr (1994) ArticleTitleThe natural history of surgically treated primary adenocarcinoma of the appendix Ann Surg 219 51–7 Occurrence Handle1:STN:280:DyaK2c7islyruw%3D%3D Occurrence Handle8297177

    CAS  PubMed  Google Scholar 

  12. GM Proulx CG Willet W Daley PC Shellito (1997) ArticleTitleAppendiceal carcinoma: patterns of failure following surgery and implications for adjuvant therapy J Surg Oncol 66 51–3 Occurrence Handle1:STN:280:DyaK2svjs1ShtA%3D%3D Occurrence Handle9290693

    CAS  PubMed  Google Scholar 

  13. N Hananel E Powsner Y Wolloch (1998) ArticleTitleAdenocarcinoma of the appendix: an unusual disease Eur J Surg 164 859–62 Occurrence Handle1:STN:280:DyaK1M%2FlvFaltw%3D%3D Occurrence Handle9845132

    CAS  PubMed  Google Scholar 

  14. P Jacquet PH Sugarbaker (1996) ArticleTitleCurrent methodologies for clinical assessment of patients with carcinomatosis J Exp Clin Cancer Res 15 49–58

    Google Scholar 

  15. PH Sugarbaker (1998) Management of Peritoneal Surface Malignancy Using Cytoreductive Surgery, Intraperitoneal Chemotherapy. A Manual for Physicians and Nurses Ludann Co Grand Rapids, MI

    Google Scholar 

  16. PH Sugarbaker D Chang (1999) ArticleTitleResults of treatment of 385 patients with peritoneal surface spread of appendiceal malignancy Ann Surg Oncol 6 727–31 Occurrence Handle1:STN:280:DC%2BD3c%2Fos1aisw%3D%3D Occurrence Handle10622499

    CAS  PubMed  Google Scholar 

  17. J Esquivel PH Sugarbaker (2001) ArticleTitleSecond-look surgery in patients with peritoneal dissemination of appendiceal malignancy. Analysis of prognostic factors in 98 patients Ann Surg 234 198–205 Occurrence Handle1:STN:280:DC%2BD3MvlslymsA%3D%3D Occurrence Handle11505065

    CAS  PubMed  Google Scholar 

  18. A Uihlein JR McDonald (1943) ArticleTitlePrimary carcinoma of the appendix resembling carcinoma of the colon Surg Gynecol Obstet 76 711–4

    Google Scholar 

  19. BM Ronnett CM Zahn RJ Kurman ME Kass PH Sugarbaker BM Shmookler (1995) ArticleTitleDisseminated peritoneal adenomucinosis and peritoneal mucinous carcinomatosis. A clinicopathologic analysis of 109 cases with emphasis on distinguishing pathologic features, site of origin, prognosis and relationship to “pseudomyxoma peritonei” Am J Surg Pathol 19 1390–408 Occurrence Handle10.1097/00000478-199512000-00006 Occurrence Handle1:STN:280:DyaK28%2FotlKktQ%3D%3D Occurrence Handle7503361

    Article  CAS  PubMed  Google Scholar 

  20. H Yan SR Pestieau BM Shmookler PH Sugarbaker (2001) ArticleTitleHistopathologic analysis in 46 patients with pseudomyxoma peritonei syndrome: failure versus success with a second-look operation Mod Pathol 14 164–71 Occurrence Handle1:STN:280:DC%2BD3M7ntVWhsQ%3D%3D Occurrence Handle11266521

    CAS  PubMed  Google Scholar 

  21. CJ Allegra S Paik LH Colangelo et al. (2003) ArticleTitlePrognostic value of thymidylate synthase, Ki-67, and p53 in patients with Dukes’ B and C colon cancer: a National Cancer Institute-National Surgical Adjuvant Breast and Bowel Project collaborative study J Clin Oncol 21 241–50 Occurrence Handle10.1200/JCO.2003.05.044 Occurrence Handle12525515 Occurrence Handle1:CAS:528:DC%2BD2cXpsVWqs78%3D

    Article  PubMed  CAS  Google Scholar 

  22. DW Hedley ML Friendlender IW Taylor CA Ruggts EA Musgrove (1983) ArticleTitleMethod for analysis of cellular DNA content of paraffin embedded pathological material using flow cytometry Cytometry 31 133–5

    Google Scholar 

  23. TV Shankley PS Rabinovitch B Bagwell et al. (1993) ArticleTitleGuidelines for implementation of clinical DNA cytometry Cytometry 14 472–7

    Google Scholar 

  24. JF Ensley Z Maciorowski H Pietrasziewicz et al. (1987) ArticleTitleSolid tumor preparation for clinical application for flow cytometry Cytometry 8 479–93 Occurrence Handle1:STN:280:DyaL1c%2FivV2isg%3D%3D Occurrence Handle2444398

    CAS  PubMed  Google Scholar 

  25. W Yu I Whang C Young A Averbach PH Sugarbaker (2001) ArticleTitleIndications for early postoperative intraperitoneal chemotherapy of advanced gastric cancer: results of a prospective randomized trial World J Surg 25 985–90 Occurrence Handle1:STN:280:DC%2BD3MrisVGmtw%3D%3D Occurrence Handle11571980

    CAS  PubMed  Google Scholar 

  26. S Gonzalez-Moreno PH Sugarbaker (2004) ArticleTitleRight hemicolectomy does not confer a survival advantage in patients with mucinous carcinoma of the appendix and peritoneal seeding Br J Surg 91 304–11 Occurrence Handle1:STN:280:DC%2BD2c7gtVSmsw%3D%3D Occurrence Handle14991630

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. The Washington Cancer Institute, 106 Irving Street, Suite N3900, N.W., Washington, DC, 20010, USA

    S. González-Moreno MD, PhD & P. H. Sugarbaker MD, FACS, FRCS

  2. Department of Pathology, Washington Hospital Center, Washington, DC, USA

    E. Brun MD, FCAP, FASCP

Authors
  1. S. González-Moreno MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. E. Brun MD, FCAP, FASCP
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. P. H. Sugarbaker MD, FACS, FRCS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to P. H. Sugarbaker MD, FACS, FRCS.

Rights and permissions

Reprints and permissions

About this article

Cite this article

González-Moreno, S., Brun, E. & Sugarbaker, P.H. Lymph Node Metastasis in Epithelial Malignancies of the Appendix With Peritoneal Dissemination Does Not Reduce Survival in Patients Treated by Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy. Ann Surg Oncol 12, 72–80 (2005). https://doi.org/10.1007/s10434-004-1161-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10434-004-1161-5

Keywords

Search

Navigation