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Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy for Pseudomyxoma Peritonei of Appendiceal Origin: A
Francesco Santullo1, Fabio Pacelli1, Carlo Abatini1
1Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Abstract:
Background: Pseudomyxoma peritonei (PMP) originating from appendiceal mucinous neoplasm is a rare peritoneal malignancy characterized by the progressive intraperitoneal accumulation of mucus leading to death if left untreated. In recent years, cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) offered increased survival rates. This study aims to identify the clinical, pathological, and surgical features influencing safety and survival outcomes of patients undergoing CRS and HIPEC for PMP of appendiceal origin. Methods: A retrospective analysis of all patients undergoing CRS and HIPEC for PMP of appendiceal origin from January 2015 to May 2019 was conducted at our institution. Results: Study population included 50 patients (74% female, 26% male). The median age at CRS was 60 (38-84). The median peritoneal cancer index (PCI) was 17. Complete cytoreductive surgery (CC 0-1) was achieved in 47 patients (94%). HIPEC chemotherapeutic regimen was based on oxaliplatin for 13 (28%) patients and mitomycin for 34 (72%) patients. We experienced a total of 19 (38%) postoperative complications, of which 14 (74%) of grade I-II and 5 (26%) of grade III-IV, according to the Clavien-Dindo classification. The median follow-up period was 27 months (12-107) from the date of cytoreductive surgery. The mean survival rate was 100 months, with a 5-year OS of 91%. The mean progression-free survival rate was 77 months (0-107), with a 5-year PFS of 63%. Multivariate analysis identified adenocarcinoma histotype and incomplete cytoreduction to significantly worsen progression-free survival, while incomplete cytoreduction was the only independent predictor of poorer overall survival. Conclusion: Complete cytoreduction and appendiceal neoplasm histotype play a crucial role in the survival of patients affected by PMP of appendiceal origin. The rates of morbidity associated with CRS and HIPEC for PMP are acceptable.
Insights
Pseudomyxoma peritonei (PMP) survival is significantly improved with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Complete cytoreduction and specific appendiceal neoplasm histotypes are crucial for better outcomes in PMP patients.
Area of Science:
- Oncology
- Surgical Oncology
- Gastroenterology
Background:
- Pseudomyxoma peritonei (PMP) is a rare, progressive peritoneal malignancy originating from appendiceal mucinous neoplasm.
- Untreated PMP is fatal due to mucus accumulation.
- Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) has emerged as a promising treatment.
Purpose of the Study:
- To identify clinical, pathological, and surgical factors influencing safety and survival in patients with appendiceal PMP treated with CRS and HIPEC.
- To evaluate the efficacy and safety of CRS and HIPEC for PMP of appendiceal origin.
Main Methods:
- Retrospective analysis of 50 patients with appendiceal PMP undergoing CRS and HIPEC between January 2015 and May 2019.
- Data collected included patient demographics, Peritoneal Cancer Index (PCI), cytoreduction completeness, HIPEC regimen, and postoperative complications.
- Follow-up data were used to assess overall survival (OS) and progression-free survival (PFS).
Main Results:
- Complete cytoreduction (CC 0-1) was achieved in 94% of patients.
- The 5-year OS was 91% and the 5-year PFS was 63%.
- Multivariate analysis revealed that adenocarcinoma histotype and incomplete cytoreduction were associated with worse PFS, while incomplete cytoreduction independently predicted poorer OS.
Conclusions:
- Complete cytoreduction is a critical factor for improving both overall and progression-free survival in appendiceal PMP.
- Appendiceal neoplasm histotype also plays a significant role in patient survival.
- The morbidity associated with CRS and HIPEC for PMP is acceptable, supporting its use in selected patients.
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