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Bai M, Li Y, Pu H, Xu Y, Chen J, Xu H, Wei H, Liang G, Ma R, Feng J. Optimal peritoneal cancer index cutoff point for predicting surgical resectability of pseudomyxoma peritonei in treatment-naive patients. World J Surg Oncol 2024; 22:39. [PMID: 38297355 PMCID: PMC10829395 DOI: 10.1186/s12957-024-03318-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/22/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND The peritoneal cancer index (PCI) has been used to predict surgical outcomes for pseudomyxoma peritonei (PMP). The present study aimed to establish the optimal cutoff point for PCI to predict surgical resectability of PMP. METHODS A total of 366 PMP patients were included. The patients were divided into low-grade and high-grade groups. Based on the completeness of the cytoreduction (CC) score, both low-grade and high-grade PMP patients were further divided into complete cytoreductive surgery (CRS) and maximal tumor debulking (MTD) subgroups. The ability to predict surgical resectability of total and selected PCI (regions 2 + 9 to 12) was analyzed through receiver operating characteristic (ROC) curves. RESULTS Both total and selected PCI demonstrated excellent discriminative ability in predicting surgical resectability for low-grade PMP patients (n = 266), with the ROC-AUC of 0.940 (95% CI: 0.904-0.965) and 0.927 (95% CI: 0.889-0.955). The corresponding optimal cutoff point was 21 and 5, respectively. For high-grade PMP patients (n = 100), both total and selected PCI exhibited good performance in predicting surgical resectability, with the ROC-AUC of 0.894 (95% CI: 0.816-0.946) and 0.888 (95% CI: 0.810-0.943); correspondingly, the optimal cutoff point was 25 and 8, respectively. The discriminative ability between total and selected PCI in predicting surgical resectability did not show a statistical difference. CONCLUSIONS Both total and selected PCI exhibited good performance and similarity in predicting complete surgical resection for both low-grade and high-grade PMP patients. However, the selected PCI was simpler and time-saving in clinical practice. In the future, new imaging techniques or predictive models may be developed to better predict PCI preoperatively, which might assist in confirming whether complete surgical resection can be achieved.
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Affiliation(s)
- Mingjian Bai
- Department of Clinical Laboratory, Aerospace Center Hospital, 15 Yuquan Road, Haidian District, Beijing, 100049, China
| | - Yunxiang Li
- Department of Clinical Laboratory, Aerospace Center Hospital, 15 Yuquan Road, Haidian District, Beijing, 100049, China
| | - Hairong Pu
- Institute of Genetics and Department of Human Genetics, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Yueming Xu
- Department of Literature and Science, University of Wisconsin-Madison, Madison, WI, 50155, USA
| | - Jingliang Chen
- Department of Clinical Laboratory, Aerospace Center Hospital, 15 Yuquan Road, Haidian District, Beijing, 100049, China
| | - Hongbin Xu
- Department of Myxoma, Aerospace Center Hospital, Beijing, 100049, China
| | - Hongjiang Wei
- Department of Radiology, Aerospace Center Hospital, Beijing, 100049, China
| | - Guowei Liang
- Department of Clinical Laboratory, Aerospace Center Hospital, 15 Yuquan Road, Haidian District, Beijing, 100049, China
| | - Ruiqing Ma
- Department of Myxoma, Aerospace Center Hospital, Beijing, 100049, China.
| | - Jing Feng
- Department of Clinical Laboratory, Aerospace Center Hospital, 15 Yuquan Road, Haidian District, Beijing, 100049, China.
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Kamada Y, Hida K, Yonemura Y, Nakakura A, Kitai T, Mizumoto A, Yoshida S, Tokoro Y, Obama K. Analysis of the characteristics and outcomes of patients with pseudomyxoma peritonei of appendiceal origin treated with curative-intent surgery. Surg Oncol 2023; 51:102012. [PMID: 37972508 DOI: 10.1016/j.suronc.2023.102012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 10/07/2023] [Accepted: 10/22/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND There are no previous studies on pseudomyxoma peritonei regarding the details of surgical procedures included in cytoreductive surgery and quantitative evaluation for peritoneal metastases by region in the abdominal cavity. This study aimed to describe the characteristics and procedural details involved in cytoreductive surgery, and survival outcomes of patients with pseudomyxoma peritonei originating from appendiceal mucinous neoplasm, and identify differences in the difficulty of cytoreductive surgery based on tumor location. METHODS Patient characteristics and survival outcomes were studied through a retrospective review. The complete cytoreduction rate (i), the 5-year survival rate for patients with complete cytoreduction (ii), and an index as a complement (i × ii × 100) were described for patients who had tumors larger than 50 mm in one of the 13 regions of the abdominal cavity. RESULTS A total of 989 patients were treated with curative-intent cytoreductive surgery. The median peritoneal cancer index was 18 (interquartile range, 6-29), with complete cytoreduction achieved in 702 patients (71%); the major complication rate was 17%. The median overall survival was 92.9 months, compared to 53.8 months for patients who underwent total gastrectomy and 30.4 months for those who underwent total colectomy. In the 13 abdominal regions, the index scores indicating cytoreduction difficulty were categorized into three risk groups: upper and mid-abdominal (>20), lateral abdominal (10-20), and small bowel (<10). CONCLUSIONS Cytoreductive surgery offered favorable survival outcomes, even in cases involving total gastrectomy. The difficulty of achieving complete cytoreduction varied across abdominal regions and was classified into three levels.
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Affiliation(s)
- Yasuyuki Kamada
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Regional Cancer Therapies, Peritoneal Surface Malignancy Treatment Center, Kishiwada Tokushukai Hospital, Kishiwada City, Osaka, Japan
| | - Koya Hida
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Yutaka Yonemura
- Department of Regional Cancer Therapies, Peritoneal Surface Malignancy Treatment Center, Kishiwada Tokushukai Hospital, Kishiwada City, Osaka, Japan; Department of Peritoneal Surface Malignancy Treatment, Omi Medical Center, Kusatsu City, Shiga, Japan
| | - Akiyoshi Nakakura
- Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toshiyuki Kitai
- Department of Regional Cancer Therapies, Peritoneal Surface Malignancy Treatment Center, Kishiwada Tokushukai Hospital, Kishiwada City, Osaka, Japan
| | - Akiyoshi Mizumoto
- Department of Peritoneal Surface Malignancy Treatment, Omi Medical Center, Kusatsu City, Shiga, Japan
| | - Shinya Yoshida
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yukinari Tokoro
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazutaka Obama
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Sugarbaker PH, Chang D. Total abdominal colectomy to facilitate complete cytoreduction in 56 patients with mucinous appendiceal neoplasms with peritoneal metastases. J Surg Oncol 2023; 127:1011-1018. [PMID: 36785941 DOI: 10.1002/jso.27211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/17/2023] [Accepted: 01/22/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND Cytoreductive surgery (CRS) and perioperative intraperitoneal chemotherapy are currently the standard of care for management of appendiceal mucinous neoplasms with peritoneal metastases. The goal of the CRS is complete removal of all visible disease through the use of peritonectomy procedures and visceral resections. One of the major resections that may be required is total abdominal colectomy (TAC). METHODS From a database and secured files of patients having a complete CRS, all patients who had TAC were identified. The clinical and histologic variables associated with these patients were identified and assessed for their impact on overall survival. RESULTS The 450 complete CRS with low-grade appendiceal mucinous neoplasms had 26 TAC (5.8%) with a 16.0-year median survival. The mucinous adenocarcinoma (MACA)-Intermediate (MACA-Int) group consisted of 37 patients with 8 patients (21.6%) having TAC that resulted in a median survival of 11.5 years. The 159 complete CRS with MACA had 22 TAC (13.8%) with a median survival of 7.5 years. There was a single mortality with a class 4 adverse event in 5 patients (10.7%). With a class 4 adverse event, survival decreased significantly (p = 0.0006, hazard ratio: 6.2). CONCLUSION Complete CRS required TAC in 56 of 646 patients (8.7%) with appendiceal mucinous neoplasms. With TAC, median survival was 12.0 years. A class 4 adverse event markedly reduced survival.
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Affiliation(s)
- Paul H Sugarbaker
- Department of Surgery, Center for Gastrointestinal Malignancies, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - David Chang
- Westat Clinical Research Group, Westat, Rockville, Maryland, USA
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Scalloping of the Liver and Spleen on Preoperative CT-Scan of Pseudomyxoma Peritonei Patients: Impact on Prediction of Resectability, Grade, Morbidity and Survival. Cancers (Basel) 2022; 14:cancers14184434. [PMID: 36139595 PMCID: PMC9496987 DOI: 10.3390/cancers14184434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/02/2022] [Accepted: 09/09/2022] [Indexed: 11/30/2022] Open
Abstract
Simple Summary Liver and/or spleen scalloping is a common radiologic sign visible on preoperative computed tomography scans of pseudomyxoma peritonei patients. While several studies have reported a predictive value of this scalloping regarding resectability, histologic grade, postoperative morbidity risk and long-term oncologic outcomes, few data are available regarding splenic scalloping. The predictive value of hepatic and splenic scalloping characteristics (measures and density) was assessed. It appeared that scalloping was associated for a more extensive disease, requiring more complex cytoreduction, but it was not associated with resectability, histologic grade, postoperative complications, or survival. Abstract Pseudomyxoma peritonei (PMP) is ideally treated by cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC), leading to significant morbidity. Beyond the histologic grade, the prognosis lies in the completeness of cytoreduction (CC-score of 0/1 vs. 2/3) and the severe complication rate. The mucinous nature of the peritoneal implants sometimes induces liver and/or spleen scalloping on imaging. The predictive value of scalloping was assessed regarding resectability, grade, survival and severe morbidity. This monocentric, retrospective analysis compared CC-0/1 with CC-2/3 groups regarding liver and spleen scalloping parameters, assessed on pre-operative computed tomography (CT) scan, reviewed for the study. In addition, prognostic factors of severe complications and recurrence-free and overall survivals were explored in the CC-0/1 population. Overall, 129 patients were included (109 CC-0/1, 20 CC-2/3), with 58 (45%) exhibiting scalloping. All patients with splenic scalloping also had a liver one. Scalloping was more frequent (75% vs. 39%), with greater median maximal depth (21 vs. 11 mm) and higher PCI (32 vs. 14) in the CC-2/3 population, but was not predictive of either grade or survival. In CC-0/1 patients, survivals and postoperative complications were not affected by scalloping parameters. Scalloping appeared as a marker of advanced PMP, but was not predictive of grade, severe complications, or long-term outcomes.
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Sugarbaker PH, Chang D. Treatment of advanced pseudomyxoma peritonei using cytoreductive surgery including total gastrectomy and perioperative chemotherapy. J Surg Oncol 2021; 124:378-389. [PMID: 33914912 DOI: 10.1002/jso.26506] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 11/10/2022]
Abstract
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.
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Affiliation(s)
- Paul H Sugarbaker
- Center for Gastrointestinal Malignancies, MedStar Washington Hospital Center, Washington, District Columbia, USA
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Dominic JL, Kannan A, Tara A, Hakim Mohammed AR, Win M, Khorochkov A, Sultan W, Ahmed A, Kantamaneni K, Syzmanski MW, Singh R, Marquez RA, Asarian A, Thirunavukarasu P, Keckeisen G. Prophylactic hyperthermic intraperitoneal chemotherapy (HIPEC) for the prevention and control of peritoneal metastasis in patients with gastrointestinal malignancies: a systematic review of randomized controlled trials. EXCLI JOURNAL 2021; 20:1328-1345. [PMID: 34650387 PMCID: PMC8495114 DOI: 10.17179/excli2021-4108] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 08/04/2021] [Indexed: 02/05/2023]
Abstract
Peritoneal metastasis is associated with poor prognosis, with studies in the literature reporting the survival of peritoneal metastasis without treatment to be three to six months. Hyperthermic intraperitoneal chemotherapy (HIPEC) has shown positive outcomes by improving the prognosis in patients with gastrointestinal malignancies. This systematic review of randomized controlled trials was done to determine the prophylactic role of hyperthermic intraperitoneal chemotherapy in preventing and controlling peritoneal metastasis gastrointestinal origin. Randomized controlled trials published between January 2019 to June 2021 were included. The databases used were MEDLINE (PubMed), EMBASE (Ovid), and the Cochrane library. Cochrane handbook for systematic review of intervention was used to assess the risk of bias in included trials. The results were reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. A total of five trials met the inclusion criteria. Two studies were on patients with gastric cancer, and the other three studies were on patients with colorectal cancer. HIPEC was given to a total of 116 gastric cancer patients and 308 colorectal cancer patients. In all the included studies on patients with gastric cancer, the peritoneal recurrence-free survival was significantly higher in the group that received HIPEC. There was no significant improvement in peritoneal-free survival in patients with colorectal cancer who received HIPEC. HIPEC appears to be effective in preventing peritoneal metastasis in patients with locally advanced gastric cancer without minimal postoperative complications. However, in patients with advanced colorectal malignancy, HIPEC does not seem to play a crucial role in preventing and controlling peritoneal metastasis.
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Affiliation(s)
- Jerry Lorren Dominic
- General Surgery, Stony Brook Medicine/Southampton Hospital, Southampton, New York, United States
| | - Amudhan Kannan
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Anjli Tara
- General Surgery, California Institute of Behavioral Neurosciences and Psychology, Fairfield, California, United States
| | - Abdul Rub Hakim Mohammed
- Emergency Medicine, The George Washington University - Kokilaben Dhirubhai Ambani Hospital & Medical Research Institute, Mumbai, India
| | - Myat Win
- General Surgery, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Arseni Khorochkov
- General Surgery, California Institute of Behavioral Neurosciences and Psychology, Fairfield, California, United States
| | - Waleed Sultan
- General Surgery, Halifax Health Medical Center, Daytona Beach, Florida, United States
| | - Asma Ahmed
- General Surgery, University of Missouri - Kansas City, Missouri, United States
| | - Ketan Kantamaneni
- General Surgery, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences & Research Foundation, Gannavaram, Andhra Pradesh, India
| | - Michael W. Syzmanski
- General Surgery, Stony Brook Medicine/Southampton Hospital, Southampton, New York, United States
| | - Rajbir Singh
- General Surgery, Stony Brook Medicine/Southampton Hospital, Southampton, New York, United States
| | - Raul A. Marquez
- Orthopedic Surgery, Cornerstone Regional Hospital/South Texas Health System, Edinburg, Texas, United States
| | - Armand Asarian
- General Surgery, The Brooklyn Hospital Center, Brooklyn, New York, United States
| | - Pragatheeshwar Thirunavukarasu
- Director of Surgical Oncology, Cape Fear Valley Medical Center, Fayetteville, North Carolina, United States and Adjunct Clinical Assistant Professor of Surgery, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, United States
- *To whom correspondence should be addressed: Pragatheeshwar Thirunavukarasu, Director of Surgical Oncology, Cape Fear Valley Medical Center, Fayetteville, North Carolina, United States; Adjunct Clinical Assistant Professor of Surgery, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, United States; Tel.: +1 910-987-5706, E-mail:
| | - George Keckeisen
- General Surgery, Stony Brook Medicine/Southampton Hospital, Southampton, New York, United States
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Paredes AZ, Guzman-Pruneda FA, Abdel-Misih S, Hays J, Dillhoff ME, Pawlik TM, Cloyd JM. Perioperative Morbidity of Gastrectomy During CRS-HIPEC: An ACS-NSQIP Analysis. J Surg Res 2019; 241:31-39. [DOI: 10.1016/j.jss.2019.03.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 02/16/2019] [Accepted: 03/22/2019] [Indexed: 12/27/2022]
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Kitai T, Yamanaka K, Sugimoto N, Inamoto O. Surgical management for peritoneal carcinomatosis of appendiceal origin with a high-tumor burden. Surg Today 2019; 50:171-177. [PMID: 31363844 DOI: 10.1007/s00595-019-01856-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 07/17/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) is the active treatment for peritoneal carcinomatosis of appendiceal origin. However, surgical management is sometimes difficult in patients with a high-tumor burden. METHODS A high-tumor burden was defined as a peritoneal cancer index (PCI) ≥ 28. Among 49 patients receiving CRS + HIPEC, 29 had a PCI ≥ 28. RESULTS Complete cytoreduction (CC-0/1) was achieved in 20 of the 29 patients with a PCI ≥ 28 and in all 20 patients with a PCI < 28. Among the patients achieving CC-0/1, gastrectomy or total colectomy was performed more frequently, the hospital stay was longer and postoperative complications were more frequent in those with a PCI ≥ 28 than in those with a PCI < 28. If CC-0/1 was achieved, the overall survival was comparable between patients with a PCI ≥ 28 and a PCI < 28. However, the recurrence-free survival was significantly worse for patients with a PCI ≥ 28 than for those with a PCI < 28 (5-year survival: 73.7% vs. 5.9%). Patients with recurrence who underwent repeat CRS showed a better overall survival than those without repeat CRS. Among patients with a PCI ≥ 28, a performance status (PS) of 2/3 was a significant prognostic factor (hazard ratio = 5.132). CONCLUSIONS In patients with a high-tumor burden undergoing CRS + HIPEC, postoperative complications were more frequent, and the recurrence rate was higher than in those without a high-tumor burden. Repeat CRS improved the survival of patients with recurrence. The PS was a key indicator when selecting patients suitable for aggressive resection.
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Affiliation(s)
- Toshiyuki Kitai
- Department of Surgery, Kishiwada City Hospital, 1001 Gakuhara-cho, Kishiwada, Osaka, 596-8501, Japan.
| | - Kenya Yamanaka
- Department of Surgery, Kishiwada City Hospital, 1001 Gakuhara-cho, Kishiwada, Osaka, 596-8501, Japan
| | - Naoko Sugimoto
- Department of Surgery, Kishiwada City Hospital, 1001 Gakuhara-cho, Kishiwada, Osaka, 596-8501, Japan
| | - Osamu Inamoto
- Department of Surgery, Kishiwada City Hospital, 1001 Gakuhara-cho, Kishiwada, Osaka, 596-8501, Japan
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Benhaim L, Faron M, Gelli M, Sourrouille I, Honoré C, Delhorme JB, Elias D, Goere D. Survival after complete cytoreductive surgery and HIPEC for extensive pseudomyxoma peritonei. Surg Oncol 2019; 29:78-83. [PMID: 31196498 DOI: 10.1016/j.suronc.2019.03.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 03/05/2019] [Accepted: 03/25/2019] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The optimal treatment for pseudomyxoma peritonei (PMP) combines complete cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC). Yet, achieving CRS is challenging in the case of extensive involvement of the peritoneal cavity and the survival benefit in this setting remains uncertain. The present study evaluated the surgical outcomes according to the peritoneal extent. METHODS Between 1992 and 2014, 245 patients underwent CRS and HIPEC for PMP in our institution. Their characteristics were reviewed using a prospective database. Extensive PMP was defined as a peritoneal cancer index (PCI) ≥ 28. Sixty-one patients with extensive PMP were compared to 184 with non-extensive PMP. RESULTS Severe complications were more frequent in the extensive group (46% vs. 23%, p < 0.001) but the post-operative mortality was not significantly different (8% vs. 3%, p = 0.1). The 5-year disease-free survival reached 45% in the extensive and 78% in the non-extensive group (p < 0.0001). The 5-year overall survival was 70% and 90% in the extensive and non-extensive group respectively (p < 0.021). CONCLUSION CRS with HIPEC offers prolonged survival even in the case of extensive PMP. Because of the high rate of surgical morbidity in the extensive group, patients should be carefully selected.
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Affiliation(s)
- Léonor Benhaim
- Department of Surgical Oncology, Gustave Roussy, Cancer Campus, 114 Rue Edouard Vaillant, 94805, Villejuif, Cedex, France.
| | - Matthieu Faron
- Department of Surgical Oncology, Gustave Roussy, Cancer Campus, 114 Rue Edouard Vaillant, 94805, Villejuif, Cedex, France
| | - Maximiliano Gelli
- Department of Surgical Oncology, Gustave Roussy, Cancer Campus, 114 Rue Edouard Vaillant, 94805, Villejuif, Cedex, France
| | - Isabelle Sourrouille
- Department of Surgical Oncology, Gustave Roussy, Cancer Campus, 114 Rue Edouard Vaillant, 94805, Villejuif, Cedex, France
| | - Charles Honoré
- Department of Surgical Oncology, Gustave Roussy, Cancer Campus, 114 Rue Edouard Vaillant, 94805, Villejuif, Cedex, France
| | - Jean-Baptiste Delhorme
- Department of General and Digestive Surgery, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, 2 Avenue Molière, 67200, Strasbourg, France
| | - Dominique Elias
- Department of Surgical Oncology, Gustave Roussy, Cancer Campus, 114 Rue Edouard Vaillant, 94805, Villejuif, Cedex, France
| | - Diane Goere
- Department of Surgical Oncology, Gustave Roussy, Cancer Campus, 114 Rue Edouard Vaillant, 94805, Villejuif, Cedex, France
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