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Surgical management of pseudomyxoma peritonei: low-volume center experience
Charif Khaled1, Lina Safar1, Alain Hendlisz2
1Department of Surgery, Université libre de Bruxelles (ULB), The Brussels University Hospital (H.U.B), Jules Bordet Institute, Brussels, Belgium.
Introduction:
Pseudomyxoma peritonei (PMP) is a rare disease characterized by diffuse peritoneal invasion of multifocal mucinous deposits. Gold standard treatment involves cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC). We aimed to compare the outcomes of operated PMP patients in a low-volume center, with those of high-volume centers and using other regimens.
Materials And Methods:
Retrospective analysis was conducted for PMP patients treated by CRS + HIPEC (using the Elias high-dose Oxaliplatin HIPEC regimen) over a 15-year period (January 2007 - December 2021) at the Jules Bordet Institute - H.U.B.
Results:
32 patients were included. Pathology results were: 21.9% acellular mucin, 34.4% low-grade, and 43.7% high-grade. The median peritoneal cancer index was 24 (range 3-36). The median follow-up was 58 months. The rate of major complications (Clavien-Dindo III/IV) was 41% and postoperative mortality was 3%. Mean disease-free survival (DFS) was estimated at 40 +/- 4 months (standard deviation (SD)) while overall survival (OS) was 122 +/- 9 months (SD). DFS reached a plateau of 44.5% at 5 and 10 years and OS was 92.3% and 76.2% respectively. Statistical analysis showed low-grade PMP to be predictive of better DFS and OS (p = 0.0111 and p = 0.0293 respectively). We also found that female gender was predictive of better DFS (p = 0.0262).
Conclusion:
Our postoperative morbidity and mortality rates, DFS, and OS were similar to those reported in the literature for high-volume PMP centers. Our theory is that surgical proficiency can be more attributed to the surgeon's CRS experience, regardless of the nature of the disease.
Insights
Pseudomyxoma peritonei (PMP) treatment using cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) at a low-volume center yielded outcomes comparable to high-volume centers. Low-grade PMP and female gender predicted better disease-free survival and overall survival.
Area of Science:
- Oncology
- Surgical Oncology
- Gastroenterology
Background:
- Pseudomyxoma peritonei (PMP) is a rare malignancy characterized by mucinous deposits throughout the peritoneum.
- Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is the established treatment standard for PMP.
Purpose of the Study:
- To evaluate the outcomes of PMP patients treated with CRS + HIPEC at a low-volume center.
- To compare these outcomes with those reported from high-volume centers and alternative treatment regimens.
Main Methods:
- A retrospective analysis of 32 PMP patients treated with CRS + HIPEC (Elias high-dose Oxaliplatin regimen) from January 2007 to December 2021.
- Evaluation of pathology, peritoneal cancer index (PCI), complication rates, disease-free survival (DFS), and overall survival (OS).
Main Results:
- Major complications occurred in 41% of patients, with a 3% postoperative mortality rate.
- Mean DFS was 40 months, and mean OS was 122 months, with 5-year DFS plateau at 44.5% and 5-year OS at 92.3%.
- Low-grade PMP and female gender were significant predictors of improved DFS and OS.
Conclusions:
- Outcomes in terms of morbidity, mortality, DFS, and OS at this low-volume center were comparable to high-volume PMP centers.
- Surgical expertise and surgeon's CRS experience are likely key factors in achieving favorable outcomes, irrespective of center volume.
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