[Pseudomyxoma peritonei treated with complete resection and immediate intraperitoneal chemotherapy]
Dominique Elias1, Stanislas Laurent, Samy Antoun
1Département de Chirurgie Générale Carcinologique, Institut Gustave Roussy, rue Camille Desmoulins, 94805, Villejuif Cedex. elias@igr.fr
Aim:
Pseudomyxoma peritonei remains a fatal disease. This clinical pathological entity based on the presence of mucin includes different prognostic groups. Complete resection of macroscopic lesions, combined with immediate intraperitoneal chemotherapy to treat remnant infra-millimetric disease, might improve survival. The aim of this prospective study was to evaluate this treatment strategy.
Methods:
Thirty-six patients with pseudomyxoma peritonei underwent resection of supra-millimetric lesions then were given either early postoperative intraperitoneal chemotherapy (5 days) (before January 1996) or intraoperative chemohyperthermia treatment (after January 1996). During this same period, only partial resection of the macroscopic lesion was possible in 15 patients; these patients were not given peritoneal chemotherapy.
Results:
Postoperative mortality was 13.8% (n=5), including 2 deaths not specifically due to the procedure. Morbidity, including severe and non-severe complications was 44%. After a mean follow-up of 48 months, the overall 5-years survival rate was 66%, and disease-free survival rate was 55% (including the postoperative deaths). The main prognostic factor in this series was the pathological grading: 5-years survival was 74% for grade 1 tumors versus 54% for grades 2-3 (P=0.05).
Conclusion:
The main prognostic factor of the pseudomyxoma peritonei, after the completeness of the resection, is the pathological grading. The addition of an intraperitoneal chemohyperthermia improves long-term survival of grades 2-3 tumors and perhaps that of grade 1 (agreement of experts). This treatment is more easily performed, more well-tolerated, and more efficient when performed early.
Insights
Pseudomyxoma peritonei treatment combining surgery and intraperitoneal chemotherapy improves survival. Pathological grade is a key prognostic factor, with chemohyperthermia benefiting higher-grade tumors.
Area of Science:
- Oncology
- Surgical Oncology
- Gastroenterology
Background:
- Pseudomyxoma peritonei (PMP) is a rare malignancy with a poor prognosis.
- Complete resection of macroscopic lesions and treatment of microscopic disease are crucial for survival.
- Prognostic factors include pathological grade and completeness of surgical resection.
Purpose of the Study:
- To evaluate the efficacy of combining complete surgical resection with early intraperitoneal chemotherapy for PMP.
- To assess the impact of pathological grading on patient outcomes.
- To compare early postoperative intraperitoneal chemotherapy with intraoperative chemohyperthermia.
Main Methods:
- A prospective study of 36 patients with PMP.
- Surgical resection of macroscopic lesions followed by either early postoperative intraperitoneal chemotherapy or intraoperative chemohyperthermia.
- Comparison with 15 patients who had partial resection without peritoneal chemotherapy.
Main Results:
- Overall 5-year survival rate was 66%, with disease-free survival at 55%.
- Postoperative mortality was 13.8%, and morbidity was 44%.
- Pathological grade was the main prognostic factor: 5-year survival was 74% for grade 1 vs. 54% for grades 2-3 (P=0.05).
Conclusions:
- Complete resection and pathological grading are key prognostic factors in PMP.
- Intraperitoneal chemohyperthermia improves long-term survival, particularly for grades 2-3 tumors.
- Early administration of this treatment strategy is more effective and better tolerated.
