Treatment of advanced pseudomyxoma peritonei using cytoreductive surgery including total gastrectomy and perioperative chemotherapy

J Surg Oncol. 2021 Sep;124(3):378-389. doi: 10.1002/jso.26506. Epub 2021 Apr 29.


Background: Pseudomyxoma peritonei is a disease caused by the widespread distribution of mucinous tumor into the peritoneal space from a perforated appendiceal neoplasm.

Methods: All patients in this study had cytoreductive surgery with total gastrectomy plus perioperative intraperitoneal chemotherapy. A high diverting jejunostomy was used on all patients. Patient characteristics, adverse events, and survival were accumulated prospectively.

Results: Fifty-eight patients were available for long-term follow-up. In the univariate analysis, features associated with a less favorable outcome included female gender (p = 0.0127), intestinal obstruction before treatment (p = 0.00791), and prior surgical score (PSS) (p = 0.0054). In the multivariate analysis, the two significant variables were grade (p = 0.0458) and PSS (p = 0.0041). Median survival was 12 years with a 5-, 10-, and 20-year survival of 76%, 58%, and 37%, respectively. There were two postoperative deaths (3.4%) and Grades 3 and 4 adverse events in 20 (34.5%) patients.

Conclusions: A 10-year survival after cytoreductive surgery, total gastrectomy with temporary high diverting jejunostomy, and perioperative chemotherapy occurred in 58% of these patients with advanced pseudomyxoma peritonei. High-grade disease and extensive prior surgery with a high PSS were associated with reduced benefit.

Keywords: EPIC; HIPEC; doxorubicin; mitomycin C; peritonectomy; visceral resections.

MeSH terms

  • Adenocarcinoma, Mucinous / drug therapy*
  • Adenocarcinoma, Mucinous / pathology
  • Adenocarcinoma, Mucinous / surgery*
  • Adult
  • Aged
  • Appendiceal Neoplasms / drug therapy*
  • Appendiceal Neoplasms / pathology
  • Appendiceal Neoplasms / surgery*
  • Cytoreduction Surgical Procedures / methods
  • Female
  • Gastrectomy / methods
  • Humans
  • Jejunostomy
  • Male
  • Middle Aged
  • Perioperative Care / methods
  • Pseudomyxoma Peritonei / drug therapy*
  • Pseudomyxoma Peritonei / pathology
  • Pseudomyxoma Peritonei / surgery*
  • Retrospective Studies
  • Survival Rate