Evidence map›Paper›PMID 42690556›Full record

ArticleJournal of gastrointestinal cancer2026

Intraoperative Systemic Chemotherapy in Stage II-III Appendiceal Adenocarcinoma: A National Cancer Database Analysis.

Michal Perets, Noam Kahana, Michael R Freund, Nir Horesh, Maher Al Khaldi, Zubair Bayat, Marylise Boutros, Sameh Hany Emile

Abstract read
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In one paragraph

Article in Journal of gastrointestinal cancer, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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0cells of the map it votes in
0citing papers in PubMed
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Michal PeretsEllen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA.
Noam KahanaEllen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA.
Michael R FreundDepartment of General surgery Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
Nir HoreshEllen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA.
Maher Al KhaldiEllen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA.
Zubair BayatEllen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA.
Marylise BoutrosEllen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA.
Sameh Hany EmileEllen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA. RIZKALS@ccf.org.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAppendiceal adenocarcinoma is a rare malignancy with a high risk of peritoneal recurrence, especially in locally advanced stages. While intraoperative systemic chemotherapy (ISC) is standard for metastatic disease, its role in non-metastatic Stage II-III patients remains controversial. This study aimed to evaluate the survival benefit of ISC in this population.

methodsWe conducted a retrospective cohort study using the National Cancer Database (2006-2022). Patients with clinical Stage II-III (T4, N0-2) appendiceal adenocarcinoma who underwent surgical resection were included. Overall survival (OS) was compared between patients who received ISC and controls using Kaplan-Meier statistics and multivariable Cox proportional hazard models.

resultsA total of 616 patients were identified, 130 (21.1%) of whom received ISC. Patients receiving ISC were more often younger, treated at academic centers, and had mucinous histology. In the unadjusted analysis, ISC was associated with a significantly longer median OS (193.8 vs. 67.7 months, p < 0.001). This survival benefit was significant for Stage II disease (p = 0.007) but not for Stage III (p = 0.43). However, after adjusting for age, grade, clinical stage, and margin status in a multivariable model, ISC was not an independent predictor of improved OS (HR 0.87, 95% CI 0.52-1.47, p = 0.611). In a subgroup analysis of only patients with mucinous and signet-ring cell carcinoma revealed that ISC was independently associated with improved OS (HR: 0.184, 95%CI: 0.044-0.762, p = 0.020).

conclusionThe findings of this large national cohort do not support the routine use of intraoperative chemotherapy in all patients with non-metastatic appendiceal cancer. However, intraoperative chemotherapy may be associated with an independent survival benefit in patients with mucinous and signet-ring cell carcinomas.

Indexed as

AdenocarcinomaAppendiceal NeoplasmsIntraoperative CareAgedChemotherapy, AdjuvantDatabases, FactualFemaleHumansMaleMiddle AgedNeoplasm StagingRetrospective StudiesAppendiceal adenocarcinomaIntraoperativeNCDB Stage II-IIISystemic chemotherapy

Identifiers

PMID42690556

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.