Right hemicolectomy is not routinely indicated in pseudomyxoma peritonei

Area of Science:

• Oncology
• Surgical Oncology
• Gastrointestinal Surgery

Background:

• Pseudomyxoma peritonei (PMP) is a rare condition predominantly caused by mucinous appendix neoplasms (MAN), distinct from appendiceal adenocarcinoma.
• The necessity of right hemicolectomy (RHC) versus appendectomy for PMP/MAN remains debated, with limited consensus on survival benefits.
• Peritoneal recurrence is common, while nodal and systemic dissemination are infrequent in PMP/MAN.

Purpose of the Study:

• To compare the survival advantage of RHC versus appendectomy in patients diagnosed with PMP/MAN.
• To investigate the impact of surgical approach on tumor recurrence, mortality, and nodal involvement.
• To identify prognostic factors influencing survival in PMP/MAN patients.

Main Methods:

• Retrospective chart review of 120 patients meeting Ronnett classification criteria for PMP/MAN.
• Comparison of recurrence rates, mortality, and nodal involvement between appendectomy (n=48) and RHC (n=72) groups.
• Multivariate logistic regression analysis to determine factors affecting survival.

Main Results:

• No significant difference in recurrence rates (21% vs. 28%) or disease-specific mortality (8% vs. 22%) between appendectomy and RHC groups.
• Lymph node involvement was observed in 7% of RHC patients, with no nodal failures in the appendectomy group.
• Optimal resection score and patient performance status, not the type of surgery, were identified as significant predictors of survival.

Conclusions:

• Appendectomy alone is a safe and effective treatment option for PMP/MAN, with no survival disadvantage compared to RHC.
• Complete cytoreduction and good performance status are critical for favorable outcomes in PMP/MAN.
• Selective RHC may be considered, as lymph node involvement is rare and does not appear to impact survival outcomes based on this study.