Cytoreduction including total gastrectomy for pseudomyxoma peritonei

Area of Science:

• Surgical Oncology
• Gastroenterology
• Oncology

Background:

• Pseudomyxoma peritonei syndrome (PPS) is treated with cytoreductive surgery and intraperitoneal chemotherapy.
• Complete resection of mucinous tumors may necessitate total gastrectomy in PPS patients.
• The stomach and its vascular supply can be extensively involved by mucinous tumor deposits.

Purpose of the Study:

• To evaluate the safety and efficacy of total gastrectomy with temporary jejunostomy in PPS patients.
• To assess the role of this combined approach in achieving complete cytoreduction.
• To analyze patient outcomes, including nutritional status and disease-free survival.

Main Methods:

• Forty-five patients with appendiceal origin PPS underwent total gastrectomy and temporary jejunostomy.
• Heated intraoperative intraperitoneal chemotherapy with mitomycin and early postoperative 5-fluorouracil were administered.
• Second-look surgery and stoma closure were performed in 39 patients, with 37 receiving additional chemotherapy.

Main Results:

• Complete cytoreduction, including total gastrectomy, was achieved in six patients.
• Most patients resumed oral nutrition after jejunostomy closure and discontinuation of parenteral feeding.
• Thirty-seven patients remain alive and disease-free at a median follow-up of 56 months, with one postoperative and one late death.

Conclusions:

• Total gastrectomy with a temporary diverting jejunostomy is a viable option for achieving complete cytoreduction in advanced PPS.
• This surgical strategy can facilitate successful treatment and improve long-term outcomes in selected patients.
• The procedure allows for extensive tumor removal while managing nutritional support and enabling eventual oral intake.