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2026.02.28

Reprinted: Expert Consensus on the Comprehensive Diagnosis and Treatment of Peritoneal Metastasis from Appendiceal Epithelial Tumors (2025 Edition)


Appendiceal epithelial tumors refer to neoplastic lesions originating from the mucosal epithelium of the appendix. These tumors exhibit marked heterogeneity in their pathological features and biological behavior. Due to their unique structural and biological characteristics, they have a high propensity for peritoneal metastasis. Currently, there is limited evidence-based medical support for the diagnosis and treatment of appendiceal epithelial tumors and their peritoneal metastases, and clinical practice still lacks unified guidelines. To address this gap, the Specialist Committee on Integrated Rehabilitation for Peritoneal Tumors of the Chinese Anti-Cancer Association has brought together multidisciplinary experts to systematically integrate specialized technical expertise around key aspects including pathological classification and clinical staging of appendiceal epithelial tumors, indications for extended resection following local excision, surgical strategies for managing concurrent peritoneal metastases, perioperative rehabilitation, and personalized treatment approaches. At the same time, the committee has standardized the perioperative management of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC), as well as the clinical application of prehabilitation protocols, thereby enhancing the practicality and operability of these procedures. Ultimately, the "Expert Consensus on Comprehensive Diagnosis and Treatment of Peritoneal Metastasis from Appendiceal Epithelial Tumors (2025 Edition)" has been developed. This consensus aims to further standardize the systematic diagnostic and therapeutic workflows for appendiceal epithelial tumors, reduce the risk of recurrence, improve patient outcomes, and promote the standardization and homogenization of the diagnosis and treatment of peritoneal metastases from these tumors.

2025.04.29

Good Doctor. Hyperthermic Intraperitoneal Chemotherapy (HIPEC): Alternative to Traditional HIPEC - Three and Four Cycles of HIPEC


Intraperitoneal hyperthermic chemotherapy (IPHC) has remained largely unchanged in the past 30 years. It is used to prevent peritoneal metastasis in patients with a high risk of disease progression in gastric or colorectal cancer, and more commonly to treat patients with peritoneal metastasis from ovarian, gastric, colorectal, and appendiceal cancers. After undergoing cytoreductive surgery, IPHC is used to help maintain a disease-free state in the peritoneal and pelvic cavities. From a theoretical perspective and analysis of IPHC failures, this treatment method has several shortcomings. First, perhaps the most serious criticism of IPHC is its insufficient "dwell time" in the peritoneal and pelvic cavities. The chemotherapy solution is maintained at 41-43 degrees Celsius using a hyperthermia pump for only 90 minutes. This limited drug exposure time is even more problematic for residual micrometastases, as high intraperitoneal concentrations of most chemotherapeutic drugs are only maintained for 30-60 minutes. High-molecular-weight drugs like paclitaxel diffuse more slowly from the peritoneal cavity. Low-molecular-weight drugs like cisplatin no longer maintain high concentrations in the peritoneal cavity after only 20 minutes. My conclusion is that increasing the dwell time of chemotherapeutic drugs in the peritoneal cavity is the primary condition for achieving greater efficacy of IPHC.

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