Safe performance of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients with HIV infection

Background

Patients with HIV (PHIV) are living longer with the adoption of anti‐retroviral therapy. As such, more patients are presenting with advanced cancer diagnoses, including peritoneal surface malignancies. The objective of this study was to assess the safety of CRS/HIPEC in this cohort of patients.

Case

Five PHIV were identified, four of whom underwent CRS/HIPEC. Primary sites of disease were low‐grade appendiceal mucinous tumors in three patients and peritoneal mesothelioma in the other. Operative time ranged from 7 to 14 h. One patient developed a Clavien grade II complication postoperatively. There was no instance of neutropenia identified. One patient died of disease 19 months after surgery; the remaining three patients are alive 11, 21, and 33 months postoperatively.

Conclusion

This study demonstrates that CRS/HIPEC can be performed in PHIV without prohibitive complications and operative recovery approximates that of non‐HIV patients. Though more study is needed, HIV should not preclude a patient from being offered CRS/HIPEC.

Mucinous Adenocarcinoma of the Appendix: The Challenges of Managing a Complex Surgical Case

Mucinous adenocarcinomas of the appendix are rare and often present as a suspected appendicitis. Diagnostic work-up encompasses colonoscopy, tissue biopsy, CT scan, and a multidisciplinary team input. Management involves surgery, hyperthermic intraperitoneal chemotherapy, and adjuvant chemotherapy. Our patient was known to be human immunodeficiency virus (HIV) positive; therefore, careful consideration had to be taken in starting adjuvant chemotherapy as there were concerns of drug interactions and further immunosuppression. Despite all these challenges the patient has had an excellent outcome with no evidence of recurrence or distant disease.