Related Experiment Video
Updated: May 2, 2026
Percutaneous Hepatic Perfusion PHP with Melphalan as a Treatment for Unresectable Metastases Confined to the Liver
Published on: July 31, 2016
Treating pseudomyxoma peritonei without heated intraperitoneal chemotherapy--a first look in New Zealand
Benjamin R Wheeler1, Sumeet K Reddy, Diane Kenwright
1Wellington Hospital, Riddiford Street, Newtown, Wellington 6021, New Zealand. BRLWheeler@gmail.com.
Background:
Pseudomyxoma peritonei is a condition characterised by dissemination of mucin-producing neoplastic cells throughout the peritoneal cavity. There are two pathological subsets, disseminated peritoneal adenomucinosis and peritoneal mucinosis carcinomatosis. Once a lethal disease, cytoreductive surgery combined with heated intraperitoneal chemotherapy (HIPEC) is challenging debulking as the standard of care.
Objective:
We present the first case series detailing the postoperative morbidity, mortality and survival outcomes of patients treated for pseudomyxoma peritonei by cytoreductive surgery without heated intraperitoneal chemotherapy by a single surgeon.
Design:
Wellington Hospital clinical databases were retrospectively searched. Inclusion criteria were a diagnosis of pseudomyxoma peritonei with a major cytoreductive operation with the intention of complete cytoreductive clearance. Exclusion criteria were palliative debulking operations and patient records not available for analysis.
Results:
25 patients underwent cytoreductive surgery between June 1999 and July 2011. Mean follow-up was 43.5 months (1.5-138). Histological classification was DPAM for 13/25 and PMCA for 12/25. Complete cytoreduction (CC-0 and CC-1) was achieved in 21/25 patients. There was no 30 day mortality following primary cytoreduction. Six patients underwent subsequent debulking/cytoreductive surgery; one patient died following repeat surgery. Clavien-Dindo grade 3 or 4 complications occurred in 7/25 patients. Combined 5-year survival was 64%, 92% for DPAM and 33% for PMCA.
Conclusion:
Cytoreductive surgery alone may result in comparable survival outcomes to those achieved with combined surgery and HIPEC in selected patients, especially for patients with DPAM.
Insights
Cytoreductive surgery alone can achieve comparable survival rates to surgery with HIPEC for pseudomyxoma peritonei, particularly for DPAM cases. This approach offers a viable alternative for selected patients.
Area of Science:
- Oncology
- Surgical Oncology
- Gastroenterology
Background:
- Pseudomyxoma peritonei involves mucin-producing cells spreading through the peritoneal cavity.
- It has two subtypes: disseminated peritoneal adenomucinosis (DPAM) and peritoneal mucinosis carcinomatosis (PMCA).
- Cytoreductive surgery with heated intraperitoneal chemotherapy (HIPEC) is the current standard treatment.
Purpose of the Study:
- To evaluate the outcomes of cytoreductive surgery without HIPEC for pseudomyxoma peritonei.
- To detail postoperative morbidity, mortality, and survival rates in a case series.
Main Methods:
- Retrospective search of Wellington Hospital clinical databases.
- Inclusion of patients with pseudomyxoma peritonei undergoing major cytoreductive surgery.
- Exclusion of palliative operations and incomplete records.
Main Results:
- 25 patients underwent surgery; 13 with DPAM, 12 with PMCA.
- Complete cytoreduction achieved in 21/25 patients with no 30-day mortality.
- 5-year survival was 64% overall (92% for DPAM, 33% for PMCA).
Conclusions:
- Cytoreductive surgery alone may offer survival outcomes comparable to HIPEC in select pseudomyxoma peritonei patients.
- DPAM patients particularly benefit from cytoreductive surgery without HIPEC.
- This suggests a potential alternative treatment strategy for specific patient groups.
