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Simultaneous bicavitary hyperthermic chemoperfusion in the management of pseudomyxoma peritonei with synchronous
Maheswari Senthil1, Lawrence E Harrison
1Division of Surgical Oncology, UMDNJ-New Jersey Medical School, 185 S Orange Ave, Newark, NJ 07103, USA.
Abstract:
Extra-abdominal spread of pseudomyxoma peritonei (PMP) is a rare event, but extension of the tumor beyond the abdomen into the pleural cavity has been reported. We report a case with synchronous pleural manifestation of PMP confirmed during abdominal cytoreductive surgery that was managed by simultaneous bicavitary hyperthermic chemoperfusion. To the best of our knowledge, this is the first report of bicavitary hyperthermic chemoperfusion for PMP. During the abdominal cytoreductive surgery in a patient with known history of PMP, extensive disease under the right hemidiaphragm was noted, requiring partial diaphragmatic resection. Once the pleural space was entered, separate mucinous deposits on the pleural surface of the diaphragm and lung surface were observed. The involved portion of the right hemidiaphragm and lung were resected. The diaphragmatic defect was left open during the hyperthermic chemoperfusion to treat both the pleural and peritoneal surfaces. The patient's postoperative course was uneventful. Simultaneous bicavitary hyperthermic chemoperfusion is a potential therapeutic option for patients with pleural extension identified during cytoreductive surgery.
Insights
Pseudomyxoma peritonei (PMP) rarely spreads outside the abdomen. This case demonstrates successful simultaneous bicavitary hyperthermic chemoperfusion for PMP with pleural involvement.
Area of Science:
- Oncology
- Surgical Oncology
- Gastroenterology
Background:
- Pseudomyxoma peritonei (PMP) is a rare malignancy characterized by mucinous ascites.
- Extra-abdominal spread, particularly to the pleural cavity, is uncommon but reported.
Observation:
- A patient with PMP presented with synchronous pleural manifestation discovered during abdominal cytoreductive surgery.
- Extensive disease was noted under the right hemidiaphragm, necessitating diaphragmatic resection and entry into the pleural space.
Findings:
- Mucinous deposits were observed on the diaphragmatic and lung pleural surfaces.
- Simultaneous bicavitary hyperthermic chemoperfusion was performed, treating both peritoneal and pleural cavities.
- The patient experienced an uneventful postoperative recovery.
Implications:
- Simultaneous bicavitary hyperthermic chemoperfusion is a viable therapeutic strategy for PMP with pleural extension.
- This approach may improve outcomes for patients with synchronous intra-abdominal and pleural disease.
- Further research is warranted to establish the efficacy and safety of this combined treatment modality.
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