The Pattern, Management, and Outcomes of Recurrence Following Cytoreductive Surgery for Pseudomyxoma Peritonei

We aimed to assess the pattern, management, and outcomes of recurrent pseudomyxoma peritonei (PMP) following cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) and compare repeat and index CRS/HIPEC.

A retrospective review was performed of patients undergoing CRS/HIPEC for PMP between 01/01/2008 and 30/06/2022 at a tertiary referral center in New Zealand. Multivariate logistic regression was used to identify independent predictors of repeat CRS/HIPEC. Overall survival (OS) of PMP recurrence was stratified according to management strategy.

Among 183 primary CRS/HIPEC for appendiceal PMP, 154 (84.2%) achieved complete cytoreduction. Median follow-up duration was 72.1 months. Forty-nine recurred (31.8%). 40 (81.6%) cases of recurrence were isolated to the peritoneal cavity, and 47 (95.9%) occurred within 5 years. 27 (55.1%) underwent repeat curative-intent surgery. 22 (44.9%) were managed with palliative intent. Age > 65 and high-grade carcinoma peritonei (HG) were independent negative predictors of repeat curative-intent surgery. Five-year overall survival was significantly higher in patients undergoing repeat curative-intent surgery (80.3%) compared to those managed with palliative intent (44.8%) (HR = 0.23, p < 0.001). Curative-intent repeat surgery was an independent predictor of overall survival in PMP recurrences. Compared to primary CRS/HIPEC, repeat CRS/HIPEC were less extensive procedures conducted in cases with a lower peritoneal cancer index. Repeat CRS/HIPEC had similar peri-operative morbidity and long-term survival to primary procedures.

Repeat CRS/HIPEC for recurrent PMP is feasible and has similar safety and efficacy to index operations. Favorable long-term outcomes are achievable in well-selected patients.