{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T07:41:23Z","timestamp":1777448483804,"version":"3.51.4"},"reference-count":20,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2025,6,30]],"date-time":"2025-06-30T00:00:00Z","timestamp":1751241600000},"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"],"abstract":"<jats:p>\n                    <jats:bold>Introduction:<\/jats:bold>\n                    Peritoneal metastases (PM) from mucinous appendix cancer (MAC) are common and often mismanaged. While cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS\/HIPEC) is standard, many patients undergo nondefinitive surgery. We compared outcomes in MAC patients undergoing CRS\/HIPEC after limited vs excessive prior surgeries.\n                    <jats:bold>Methods:<\/jats:bold>\n                    We conducted a retrospective analysis of MAC patients (1998-2023) from a single-center prospective database who underwent CRS\/HIPEC. Surgical history was evaluated using the prior surgical score (PSS). Perioperative characteristics were compared between PSS-0\/1 and PSS-2\/3 groups. Logistic regression identified factors associated with extensive prior surgery. Overall survival (OS) was analyzed with Kaplan-Meier and Cox regression.\n                    <jats:bold>Results:<\/jats:bold>\n                    Of 351 eligible cases, 221 (63%) had PSS-0\/1 and 130 (37%) had PSS-2\/3. Most individuals with PSS-2\/3 were women (89.2%, n = 116). Only female sex was significantly associated with the higher likelihood of PSS-2\/3 (odds ratio: 9.02,\n                    <jats:italic>P<\/jats:italic>\n                    &lt; .001). PSS-2\/3 patients had longer time from diagnosis to CRS\/HIPEC (\n                    <jats:italic>P<\/jats:italic>\n                    &lt; .001), longer CRS\/HIPEC procedure (\n                    <jats:italic>P<\/jats:italic>\n                    = .007), and greater blood loss (\n                    <jats:italic>P<\/jats:italic>\n                    = .038). Complete cytoreduction (CC) rates were similar (\n                    <jats:italic>P<\/jats:italic>\n                    = .227). Despite comparable major complication rates, PSS-2\/3 patients had more transfusions (\n                    <jats:italic>P<\/jats:italic>\n                    = .016), infections (\n                    <jats:italic>P<\/jats:italic>\n                    = .048), and pulmonary complications (\n                    <jats:italic>P<\/jats:italic>\n                    = .028). Five-year OS was 76% and 66% for PSS-0\/1 and PSS-2\/3 groups, respectively (\n                    <jats:italic>P<\/jats:italic>\n                    = .049). After adjusting for age, tumor burden, CC-score, and histology, PSS-2\/3 was not significantly associated with shorter OS (hazard ratio: 1.32;\n                    <jats:italic>P<\/jats:italic>\n                    = .139).\n                    <jats:bold>Conclusion:<\/jats:bold>\n                    Females with MAC are more likely to have extensive surgeries, delaying CRS\/HIPEC and compromising safety. This highlights the importance of general surgeons and gynecologists limiting the surgical extent and referring patients to an HIPEC center.\n                  <\/jats:p>","DOI":"10.1177\/00031348251353806","type":"journal-article","created":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:50:31Z","timestamp":1751331031000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["The Effect of Prior Nondefinitive Surgery on Perioperative Outcomes and Survival in Mucinous Appendix Cancer Patients Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-9778-4208","authenticated-orcid":false,"given":"Sergei","family":"Iugai","sequence":"first","affiliation":[{"name":"Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vadim","family":"Gushchin","sequence":"additional","affiliation":[{"name":"Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3376-3827","authenticated-orcid":false,"given":"Mary C.","family":"King","sequence":"additional","affiliation":[{"name":"Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3921-7210","authenticated-orcid":false,"given":"Vladislav","family":"Kovalik","sequence":"additional","affiliation":[{"name":"Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kseniia","family":"Uzhegova","sequence":"additional","affiliation":[{"name":"Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5065-1416","authenticated-orcid":false,"given":"Luis F.","family":"Falla-Zuniga","sequence":"additional","affiliation":[{"name":"Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carol","family":"Nieroda","sequence":"additional","affiliation":[{"name":"Surgical Oncology, The Institute for Cancer Care, 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, The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, 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