Travel and Outcomes for Appendix Cancer Patients Undergoing CRS/HIPEC

Abdominal Cancers Alliance
Nov 3
2 min read

Vladislav Kovalik, MD, MSPH; Armando Sardi, MD, FACS; Mary Caitlin King, BS; Sergei Iugai, MD; Luis Felipe Falla-Zuniga, MD; Carol Nieroda, MD; and Vadim Gushchin, MD, FACS

The Institute for Cancer Care at Mercy Medical Center, Baltimore, MD

Presentation Patterns and Treatment Outcomes in Appendix Cancer Patients Traveling to a High-Volume Peritoneal Surface Malignancy Center. Am Surg. 2025 Nov;91(11):1889-1897. doi: 10.1177/00031348251337155. Epub 2025 May 5. PMID: 40322888.

Background

Mucinous appendix cancer (MAC) often spreads to the lining of the abdomen (peritoneum) and is best treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC). Because this treatment is highly specialized, most patients must travel to a peritoneal surface malignancy center (PSMC) — hospitals with extensive expertise in CRS/HIPEC procedures.

This study explored how travel distance affects how and when patients with MAC present for treatment, and whether traveling long distances impacts surgical quality, complications, or survival outcomes.

Study Overview

Researchers analyzed data from 369 MAC patients treated with CRS/HIPEC at a high-volume PSMC between 1998 and 2023.

Patients were divided into two groups:

In-State: Maryland residents
Out-of-State: Patients traveling from other U.S. states

The study examined:

Time from diagnosis to surgery
Tumor burden (Peritoneal Cancer Index, PCI)
Prior treatments
Surgical quality and complication rates
Overall survival

Key Findings

Travel Distance: Out-of-state patients traveled a median of 180 miles, compared to 29 miles for in-state patients.
Delayed Care: Out-of-state patients had a longer time from diagnosis to CRS/HIPEC (median 4.6 vs. 2.8 months).
More Advanced Disease: Out-of-State patients presented with higher tumor burden (PCI 32 vs. 24) and were more likely to have undergone prior surgery or chemotherapy before referral.
Similar Quality and Safety: Despite arriving with more advanced disease, rates of complete cytoreduction (85% vs. 91%), major complications, and survival outcomes were comparable between the two groups.
Long-Term Survival: Ten-year overall survival was 66% for out-of-state and 67% for in-state patients — showing no negative impact from traveling for care.

What This Means

Patients who travel longer distances to receive CRS/HIPEC at experienced, high-volume centers may face delays and more complex disease at diagnosis. However, traveling does not compromise surgical quality, safety, or survival when treated at expert PSMCs.

These results emphasize:

The importance of early referral to specialized centers
The need for patient navigation and travel support to reduce treatment delays
The value of centralized care for rare cancers like MAC

Conclusion

Traveling to a high-volume center for CRS/HIPEC may mean a longer journey to treatment — but patients achieve equally strong outcomes when care is delivered by experienced teams. Improving referral pathways, education for general surgeons, and support for travel logistics can help patients with appendix cancer access life-saving treatment without unnecessary delays.