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Survival analysis of pseudomyxoma peritonei patients treated by cytoreductive surgery and hyperthermic
Robert M Smeenk1, Vic J Verwaal, Ninja Antonini
1Department of Surgery, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands. r.smeenk@nki.nl
Objective:
To evaluate the survival of patients with pseudomyxoma peritonei (PMP) treated by cytoreductive surgery and intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC), and to identify factors with prognostic value.
Summary Background Data:
PMP is a clinical syndrome characterized by progressive intraperitoneal accumulation of mucous and mucinous implants, usually derived from a ruptured mucinous neoplasm of the appendix. Survival is dominated by pathology.
Methods:
A total of 103 patients (34 men and 69 women) treated at The Netherlands Cancer Institute between 1996 and 2004 were identified. Survival was calculated from date of initial treatment and corrected for a second procedure. PMP was pathologically categorized into disseminated peritoneal adenomucinosis (DPAM), peritoneal mucinous carcinomatosis (PMCA), and an intermediate subtype (PMCA-I). Clinical and pathologic factors were analyzed to identify their prognostic value for survival.
Results:
Median follow-up was 51.5 months (range, 0.1-99.5 months). Recurrence developed in 44%. A second procedure for recurrence was performed in 11 patients. The median disease-free interval was 25.6 months (95% confidence interval [CI], 14.8-43.6 months). The 3-year and 5-year disease-free survival probability was 43.6% (95% CI, 34.4%-55.2%) and 37.4% (95% CI, 28.2%-49.5%), respectively. The disease-specific 3-year and 5-year survival probability was 70.9% (95% CI, 62.0%-81.2%) and 59.5% (95% CI 48.7%-72.5%), respectively. Factors associated with survival were pathological subtype, completeness of cytoreduction, and degree and location of tumor load (P < 0.05). The main prognostic factor, independently associated with survival, was the pathologic subtype (P < 0.01).
Conclusion:
Cytoreductive surgery in combination with intraoperative HIPEC is a feasible treatment strategy for PMP in terms of survival. The pathologic subtype remains the dominant factor in survival. Patients should be centralized to improve survival by a combination of surgical experience and adequate patient selection.
Insights
Cytoreductive surgery with intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) improves survival for pseudomyxoma peritonei (PMP). Pathologic subtype is the most significant prognostic factor for patient survival.
Area of Science:
- Oncology
- Surgical Oncology
- Gastroenterology
Background:
- Pseudomyxoma peritonei (PMP) is a rare condition characterized by mucinous ascites and peritoneal implants, typically originating from appendiceal neoplasms.
- Patient survival in PMP is significantly influenced by the underlying pathology and disease burden.
Purpose of the Study:
- To assess the survival outcomes of patients with PMP treated with cytoreductive surgery and intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC).
- To identify clinical and pathological factors that predict prognosis in PMP patients.
Main Methods:
- A retrospective analysis of 103 PMP patients treated between 1996 and 2004.
- Patients underwent cytoreductive surgery combined with intraoperative HIPEC.
- Pathological classification included disseminated peritoneal adenomucinosis (DPAM), peritoneal mucinous carcinomatosis (PMCA), and an intermediate subtype (PMCA-I).
Main Results:
- The median follow-up was 51.5 months, with a 44% recurrence rate.
- Disease-specific 5-year survival probability was 59.5%.
- Pathologic subtype, completeness of cytoreduction, and tumor load were significantly associated with survival; pathologic subtype was the strongest independent predictor.
Conclusions:
- Cytoreductive surgery plus HIPEC is a viable treatment for PMP, offering improved survival.
- Pathologic classification remains the most critical determinant of patient prognosis.
- Centralization of PMP care to experienced centers may enhance survival through improved surgical expertise and patient selection.
