{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T07:38:55Z","timestamp":1777448335649,"version":"3.51.4"},"reference-count":29,"publisher":"SAGE Publications","issue":"11","license":[{"start":{"date-parts":[[2025,5,5]],"date-time":"2025-05-05T00:00:00Z","timestamp":1746403200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The American Surgeon\u2122"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Mucinous appendix cancer (MAC) treatment is centralized at peritoneal surface malignancy centers (PSMCs), requiring patients to travel for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS\/HIPEC). We compared presentation patterns and outcomes for patients accessing a high-volume PSMC from in-state (I-S) vs out-of-state (O-S).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This cohort study of MAC patients with peritoneal metastases treated with CRS\/HIPEC (1998-2023) used a prospective database. Travel distance, presentation (time from diagnosis [TFD], peritoneal cancer index [PCI], prior surgery score [PSS], and systemic chemotherapy [SCh]), quality (complete cytoreduction [CC-0\/1] and grade III\/IV Clavien-Dindo complications), and overall survival (OS) were compared between O-S and I-S patients. A hazard ratio (HR) with 95% confidence interval (CI) for 10-year OS was evaluated using Cox regression for O-S travel, adjusting for age, histology, PCI, and prior treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Overall, 369 patients were included: 223 (60.4%) O-S and 146 (39.6%) I-S, with median travel distances of 180 [IQR: 83-729] and 29 [IQR: 14-59] miles, respectively. Compared to I-S, O-S had longer TFD (median: 4.6 vs 2.8\u00a0months,\n                      <jats:italic>P<\/jats:italic>\n                      &lt; 0.001), higher PCI (median: 32 vs 24,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.001), and higher rates of PSS-2\/3 (40.4% vs 28.6%,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.023) and SCh (31.8% vs 19.2%,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.007). CC-0\/1 (84.8% vs 91.4%,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.063) and major complication (15.2% vs 21.4%,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.132) rates were comparable. O-S travel did not affect OS (HR: 1.08 [95% CI: 0.73, 1.61]).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Traveling to a PSMC is associated with delayed presentation, more advanced disease, and prior treatments. However, quality and survival outcomes remain unaffected. Early referral and support for travel are essential.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00031348251337155","type":"journal-article","created":{"date-parts":[[2025,5,5]],"date-time":"2025-05-05T06:26:46Z","timestamp":1746426406000},"page":"1889-1897","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Presentation Patterns and Treatment Outcomes in Appendix Cancer Patients Traveling to a High-Volume Peritoneal Surface Malignancy Center"],"prefix":"10.1177","volume":"91","author":[{"given":"Vladislav","family":"Kovalik","sequence":"first","affiliation":[{"name":"Surgical Oncology, Mercy Medical Center, Baltimore, MD, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4132-9489","authenticated-orcid":false,"given":"Armando","family":"Sardi","sequence":"additional","affiliation":[{"name":"Surgical Oncology, Mercy Medical Center, Baltimore, MD, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary Caitlin","family":"King","sequence":"additional","affiliation":[{"name":"Surgical Oncology, Mercy Medical Center, Baltimore, MD, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-9778-4208","authenticated-orcid":false,"given":"Sergei","family":"Iugai","sequence":"additional","affiliation":[{"name":"Surgical Oncology, Mercy Medical Center, Baltimore, MD, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luis Felipe","family":"Falla-Zuniga","sequence":"additional","affiliation":[{"name":"Surgical Oncology, Mercy Medical Center, Baltimore, MD, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carol","family":"Nieroda","sequence":"additional","affiliation":[{"name":"Surgical Oncology, Mercy Medical Center, Baltimore, MD, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vadim","family":"Gushchin","sequence":"additional","affiliation":[{"name":"Surgical Oncology, Mercy Medical Center, Baltimore, MD, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,5,5]]},"reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.10589"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1111\/his.13975"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.32881"},{"key":"e_1_3_5_5_2","unstructured":"NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines\u00ae) for Colon cancer V.5.2024. https:\/\/www.nccn.org\/professionals\/physician_gls\/pdf\/colon.pdf. 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