An International Registry of Peritoneal Carcinomatosis from Appendiceal Goblet Cell Carcinoma Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

PURPOSE

Peritoneal carcinomatosis from appendiceal goblet cell carcinoma (A-GCC) is a rare and aggressive form of appendiceal tumor. Cytoreductive surgery (CRS) and hyperthermic intra peritoneal chemotherapy (HIPEC) was reported as an interesting alternative regarding survival compared to surgery without HIPEC and/or systemic chemotherapy. Our aim was to evaluate the impact of CRS and HIPEC for patients presenting A-GCC through an international registry.

METHODS

A prospective multicenter international database was retrospectively searched to identify all patients with A-GCC tumor and peritoneal metastases who underwent CRS and HIPEC through the Peritoneal Surface Oncology Group International (PSOGI). The post-operative complications, long-term results, and principal prognostic factors were analyzed.

RESULTS

The analysis included 83 patients. After a median follow-up of 47 months, the median overall survival (OS) was 34.6 months. The 3- and 5-year OS was 48.5% and 35.7%, respectively. Patients who underwent complete macroscopic CRS had a significantly better survival than those treated with incomplete CRS. The 5-year OS was 44% and 0% for patients who underwent complete, and incomplete CRS, respectively (HR 9.65, p < 0.001). Lymph node involvement and preoperative chemotherapy were also predictive of a worse prognosis. There were 3 postoperative deaths, and 30% of the patients had major complications.

CONCLUSION

CRS and HIPEC may increase long-term survival in selected patients with peritoneal metastases of A-GCC origin, especially when complete CRS is achieved. Ideally, randomized control trials or more retrospective data are needed to confirm CRS and HIPEC as the gold standard in this pathology.

Ecosystem studies on upper region of Ganga River, India

A multi-disciplinary research programme on the Ganga River Ecosystem was launched by the Government of India in 1983 to collect information on its attributes. Monitoring of the initial 509 km unpolluted and unmonitored region of the river falling in partly mountainous and partly upper plain stretches for two years revealed good water quality. The Song River (a tributary) catchment, a victim of extensive mining activity in the past, was found to add maximum mineral load. The Bhagirathi River was found to carry maximum suspended solid load. Organic pollution was low throughout, occasionally showing seasonal and local peaks. The river exhibited a high oxidative state with pH falling in a slightly alkaline range and nutrient levels being very low.Diatoms formed a major part of the encountered genera of phytoplankton. Zooplankton were mainly represented by protozoans. Saprophytic bacteria underwent large spatial and temporal fluctuations. Coliforms exhibited an increasing trend with downstream river distance. The source of pollution could not be specifically characterized from an FC/FS ratio. Only one sample tested positive for enteric virus. The forms of benthic macroinvertebrates indicated a clean stream environment. It was observed that diversity indices, together with evenness and community comparison, could provide a promising approach to determine the state of the community.Eight heavy metals investigated, Cu, Zn, Fe, Cd, Mn, Pb, Ni and Co, were found to be present in the river water and bed sediments. The prominent mode of metal transport was found to be via the suspended load. The concentration of dissolved metals was found within WHO permissible limits. The heavy metal status of the Ganga River was compared with other rivers of the world. Sorptive properties of sediments were found to be similar to the general sorptive behaviour of the clays. Laboratory studies exhibited reasonable short t 90 values for coliform survival in Ganga water. Faecal streptococcus survived longer.