Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy in the Management of Pseudomyxoma Peritonei: A Single-Center Experience

Indian J Gastroenterol. 2017 Nov;36(6):452-458. doi: 10.1007/s12664-017-0799-4. Epub 2017 Nov 29.

Abstract

Background and aims: Pseudomyxoma peritonei (PMP) results from perforated appendiceal tumors. It is usually diagnosed preoperatively by imaging. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), although aggressive long procedure with high complications rate, was considered the optimal treatment. This study is aiming to study the role of CRS and HIPEC in the management of PMP and assess the outcome.

Methods: This is a retrospective study which was conducted at King Faisal Hospital and Research Center, a tertiary care hospital during the period from November 2008 to June 2016. Approval of the Research Advisory Council was obtained. Forty-one procedures of CRS and HIPEC were performed in 38 patients. Using the open abdomen technique, CRS was performed using standard peritonectomy procedures and visceral resections directed toward the complete elimination of tumors from abdominopelvic cavity. HIPEC was performed using mitomycin C in a dose of 30 mg/m2 and allowed to circulate in abdominopelvic cavity for 90 min at 41.0 to 42.2 °C.

Results: Forty-one procedures were performed in 38 patients. Three procedures were done as repeat CRS and HIPEC. No perioperative mortality. Cystoscopy and bilateral ureteric stents in 35 procedures (85.5%). Hospital stay (range 9-85 days) average is 21 days. Follow up period is 1-84 months, and median follow up is 54 months. Five-year survival rate is 92%. Median 5-year disease-free survival rate is 60%. Two patients died during the follow up period by septic shock and one patient died from disease progression.

Conclusion: CRS and HIPEC is well-tolerated and feasible management for PMP.

Keywords: Cytoreductive surgery; Hyperthermic intraperitoneal chemotherapy; Management; Outcome; Pseudomyxoma peritonei.

MeSH terms

  • Adult
  • Aged
  • Combined Modality Therapy
  • Cytoreduction Surgical Procedures / methods*
  • Feasibility Studies
  • Female
  • Follow-Up Studies
  • Humans
  • Hyperthermia, Induced / methods*
  • Male
  • Middle Aged
  • Peritoneal Neoplasms / therapy*
  • Pseudomyxoma Peritonei / therapy*
  • Retrospective Studies
  • Survival Rate
  • Time Factors
  • Treatment Outcome