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Complete pathologic response after two-stage cytoreductive surgery with HIPEC for bulky pseudomyxoma peritonei: proof
Olivia Sgarbura1,2, Mohammed Al Hosni3, Andrea Petruzziello4
1Surgical Oncology Department, Montpellier Cancer Institute, University of Montpellier, Montpellier, France.
Abstract:
Introduction: Pseudomyxoma peritonei (PMP) is a rare disease characterized by the progressive accumulation of mucinous ascites and peritoneal implants. The optimal treatment for PMP includes the association of complete cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC). For patients with a large burdensome disease, the completeness of cytoreduction sometimes requires maximal effort surgery. The aim of this article is to provide proof of concept for two stage cytoreductive surgery (CRS) in this category of patients.Methods and materials: A two stage CRS and HIPEC with oxaliplatin was proposed for patients with bulky PMP including important involvement of the serosal surfaces of the bowel or colon who had an impaired nutritional status. The residual disease at the end of the first stage was less than 5 mm of thickness on several implants. Clinical, surgical and histopathological variables were analyzed.Results: All eight patients completed the two-stage strategy. Mortality was nil. One Clavien Dindo grade 3 event occurred in each stage. After a median follow up of 29.5 months, all patients were alive and free of recurrence. All of the patients had histopathological complete response on the specimens obtained from the residual sites during the second stage surgery.Conclusions: Two-stage surgical strategy is feasible for bulky PMP patients and it is associated with little high-grade morbidity and enhanced visceral sparing.
Insights
A two-stage cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is a feasible approach for extensive pseudomyxoma peritonei (PMP). This strategy offers a safe and effective treatment option for patients with bulky disease, achieving complete response with low morbidity.
Area of Science:
- Oncology
- Surgical Oncology
Background:
- Pseudomyxoma peritonei (PMP) is a rare malignancy characterized by mucinous ascites and peritoneal implants.
- Complete cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is the standard treatment for PMP.
- Extensive PMP may necessitate maximal surgical effort for complete cytoreduction.
Purpose of the Study:
- To evaluate the feasibility and outcomes of a two-stage CRS and HIPEC strategy for patients with bulky PMP.
- To establish proof of concept for this approach in managing extensive PMP with significant visceral involvement.
Main Methods:
- A two-stage CRS and HIPEC regimen using oxaliplatin was designed for patients with bulky PMP and impaired nutritional status.
- Patients underwent a first surgical stage with residual disease <5mm, followed by a second stage after a suitable interval.
- Clinical, surgical, and histopathological data were collected and analyzed.
Main Results:
- All eight patients successfully completed the two-stage surgical strategy without mortality.
- Each stage was associated with one Clavien-Dindo grade 3 morbidity event.
- After a median follow-up of 29.5 months, all patients remained alive and recurrence-free.
- Histopathological complete response was achieved in all patients from residual disease sites during the second stage.
Conclusions:
- A two-stage surgical approach is a feasible and safe option for managing extensive pseudomyxoma peritonei.
- This strategy is associated with low high-grade morbidity and facilitates enhanced visceral sparing.
- The two-stage CRS and HIPEC offers a promising treatment for bulky PMP, leading to complete response and long-term survival.
