Recurrence and outcome after complete tumour removal and hyperthermic intraperitoneal chemotherapy in 512 patients with pseudomyxoma peritonei from perforated appendiceal mucinous tumours

Eur J Surg Oncol. 2015 Mar;41(3):396-9. doi: 10.1016/j.ejso.2014.08.476. Epub 2014 Sep 2.


Background: Pseudomyxoma peritonei (PMP) usually originates from perforated mucinous appendiceal tumours and may present unexpectedly at surgery, or be suspected at cross sectional imaging. The optimal treatment involves macroscopic tumour removal by cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC). The 10-year Kaplan-Meier predicted disease-free survival is 61%. Some patients with recurrence are amenable to further CRS and HIPEC.

Aim: To evaluate the outcomes of re-do surgery in a large single centre series of reoperation for recurrence of peritoneal surface malignancy.

Method: Retrospective analysis of prospective database of 752 patients undergoing CRS for perforated appendiceal tumours analysed. Routine follow up involved annual CT scans and serum tumour marker measurement. The survival and recurrence in the 512/752 (68.1%) who had complete cytoreduction between March 1994 and January 2012 was calculated by Kaplan-Meier univariate analysis.

Results: Overall 137/512 (26.4%) developed recurrence and of those 35/137 (25.5%) underwent repeat surgery. Complete tumour removal was again achieved in 20/35 (57.1%). There were no postoperative deaths and no significant difference in early postoperative complications and length of stay compared to primary CRS surgery. The 5-year survival in the 375 without recurrence, the 35 who had re-do surgery and the 102 who had recurrence with no surgery was 90.9%, 79.0% and 64.5% respectively.

Conclusion: Approximately one in four patients develops recurrence after complete CRS and HIPEC for PMP of appendiceal origin. Selected patients can undergo salvage surgery with good outcomes.

Keywords: Mucinous; Peritoneal malignancy; Peritoneal neoplasms; Pseudomyxoma peritonei; Recurrence; Surgery.

MeSH terms

  • Adenocarcinoma, Mucinous / secondary
  • Adenocarcinoma, Mucinous / therapy*
  • Adult
  • Aged
  • Aged, 80 and over
  • Antineoplastic Agents
  • Appendiceal Neoplasms / pathology*
  • Combined Modality Therapy / methods
  • Cytoreduction Surgical Procedures
  • Disease-Free Survival
  • Female
  • Humans
  • Hyperthermia, Induced / methods*
  • Infusions, Parenteral
  • Male
  • Middle Aged
  • Mitomycin / therapeutic use*
  • Neoplasm Recurrence, Local*
  • Peritoneal Neoplasms / secondary
  • Peritoneal Neoplasms / therapy*
  • Peritoneum / surgery*
  • Pseudomyxoma Peritonei / therapy*
  • Reoperation
  • Retrospective Studies
  • Young Adult


  • Antineoplastic Agents
  • Mitomycin