ASO Author Reflections: Let’s Redouble Efforts to Stop Peritoneal Recurrence in All Types of Appendix Cancer

Excerpt

Although recurrence rates vary across histologies, appendiceal cancer (AC) recurrence remains a common concern even after successful cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC).^1,2 The current therapeutic approach for this challenging clinical scenario is guided by AC histopathology and the location of recurrence, either intraperitoneal (IPR) or extraperitoneal (EPR). Conventional understanding suggests that low-grade (LG) AC neoplasms predominantly spread within the peritoneum, whereas higher grade (HG) tumors tend to follow a systemic course, developing both peritoneal and distant metastases.³ Interestingly, most iterative CRS/HIPECs reported in the literature are performed for recurrent LG AC, supporting the notion that IPR is more common in these cases.^1,4 However, a significant proportion of patients with HG with/without signet ring cells (SRC) also experience only local IPR and account for up to 41.4% of reported iterative procedures.^1,4 Upon closer examination, it becomes evident that our current perception of AC relapse lacks solid evidence that can either confirm or reject it. Yet, this knowledge is important as it aids in comprehending AC biology, tailoring follow-up duration and frequency, and planning management of the disease progression. …