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International Journal of Colorectal Disease

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01-03-2005 | Original Article

Cytoreductive surgery and intraperitoneal chemotherapy for pseudomyxoma peritonei

Authors: Z. Güner, U. Schmidt, M. H. Dahlke, H. J. Schlitt, J. Klempnauer, P. Piso

Published in: International Journal of Colorectal Disease | Issue 2/2005

Abstract

Background and aims

Surgical improvement can be achieved in selected patients with pseudomyxoma peritonei (PMP) by major cytoreductive surgery and intraperitoneal chemotherapy (IPEC). The purpose of this retrospective study was to analyze morbidity, mortality, and survival following therapy.

Patients and methods

Between July 1995 and September 2003, 28 patients (mean age 56 years, range 28–79) with PMP were operated on with the aim of complete macroscopical cytoreduction. Surgery was followed by IPEC.

Results

A macroscopically complete cytoreduction was achieved in 11 patients (40%). The mean operating time was 6 h with a mean of three peritonectomy procedures per patient. Cisplatin (15 out of 28), mitomycin C (6 out of 28) and 5-FU (7 out of 28) were used for the intraoperative chemotherapy. Overall morbidity was 36%. Most frequent surgical complications were digestive fistulae (3 out of 28), abscesses (5 out of 28) and bleeding (2 out of 28). Two patients died postoperatively. Patients with low tumor volume (mean survival time 78±11 vs. 37±9 months, p=0.05) and complete cytoreduction (73±10 vs. 24±8 months, p<0.05) had an improved prognosis.

Conclusions

Cytoreductive surgery combined with IPEC is associated with acceptable morbidity and mortality. Complete cytoreduction may improve survival, particularly in selected patients with PMP who have a low tumor volume, complete cytoreduction, and no organ metastases.

Smith JW, Kemeny N, Caldwell C, Banner P, Sigurdson E, Huvos A (1992) Pseudomyxoma peritonei of appendiceal origin. Cancer 70:396–401PubMed

Ronnett BM, Yan H, Kurman RJ, Shmookler BM, Wu L, Sugarbaker PH (2001) Patients with pseudomyxoma peritonei associated with disseminated peritoneal adenomucinosis have a significantly more favorable prognosis than patients with peritoneal mucinous carcinomatosis. Cancer 92:85–91CrossRefPubMed

Gough DB et al (1994) Pseudomyxoma peritonei. Long-term patient survival with an aggressive regional approach. Ann Surg 219:112–119PubMed

Sugarbaker PH, Jablonski KA (1995) Prognostic features of 51 colorectal and 130 appendiceal cancer patients with peritoneal carcinomatosis treated by cytoreductive surgery and intraperitoneal chemotherapy. Ann Surg 221:124–132PubMed

Sugarbaker PH (2002) Cytoreduction including total gastrectomy for pseudomyxoma peritonei. Br J Surg 89:208–212CrossRefPubMed

Sugarbaker PH (1995) Peritonectomy procedures. Ann Surg 221:29–42PubMed

Carmignani CP, Sugarbaker TA, Bromley CM, Sugarbaker PH (2003) Intraperitoneal cancer dissemination: mechanisms of the patterns of spread. Cancer Metastasis Rev 22:465–472CrossRefPubMed

De Bree E, Witkamp AJ, Zoetmulder FAN (2002) Intraperitoneal chemotherapy for colorectal cancer. J Surg Oncol 79:46–61CrossRefPubMed

Elias D, Blot F, El Otmany A et al (2001) Curative treatment of peritoneal carcinomatosis arising from colorectal cancer by complete resection and intraperitoneal chemotherapy. Cancer 92:71–76CrossRefPubMed

10.

Elias D, Laurent S, Antoun S et al (2003) Pseudomyxoma peritonei treated with complete resection and immediate intraperitoneal chemotherapy. Gastroenterol Clin Biol 27:407–412PubMed

11.

Sugarbaker PH (2001) Cytoreductive surgery and peri-operative intraperitoneal chemotherapy as a curative approach to pseudomyxoma peritonei syndrome. Eur J Surg Oncol 27:239–243CrossRefPubMed

12.

Sugarbaker PH, Chang D (2000) Results of treatment of 385 patients with peritoneal surface spread of appendiceal malignancy. Ann Surg Oncol 6:727–731

13.

Glehen O, Mithieux F, Osinsky D et al (2003) Surgery combined with peritonectomy procedures and intraperitoneal chemohyperthermia in abdominal cancers with peritoneal carcinomatosis: a phase II study. J Clin Oncol 21:799–806CrossRefPubMed

14.

Loggie BW, Fleming RA, McQuellon RP et al (2000) Cytoreductive surgery with intraperitoneal hyperthermic chemotherapy for disseminated peritoneal cancer of gastrointestinal origin. Am Surg 66:561–569PubMed

15.

Pilati P, Mocellin S, Rossi CR et al (2003) Cytoreductive surgery combined with hyperthermic intraperitoneal intraoperative chemotherapy for peritoneal carcinomatosis arising from colon adenocarcinoma. Ann Surg Oncol 10:508–513CrossRefPubMed

16.

Verwaal VJ, van Ruth S, De Bree E et al (2003) Randomized trial of cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and palliative surgery in patients with peritoneal carcinomatosis of colorectal cancer. J Clin Oncol 21:3737–3743CrossRefPubMed

17.

Lang H, Jahne J, Flemming P, Meyer HJ, Pichlmayr R (1995) Pseudomyxoma peritonei of appendiceal origin—a report of seven cases and a review of published reports. Eur J Surg 161:355–360PubMed

18.

Piso P, Bektas H, Werener U et al (2001) Improved prognosis following peritonectomy procedures and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis from appendiceal carcinoma. Eur J Surg Oncol 27:286–290CrossRefPubMed

19.

Stephens AD, Aldermann R, Chang D et al (2000) Morbidity and mortality analysis of 200 treatments with cytoreductive surgery and hyperthermic intraoperative chemotherapy using the Coliseum technique. Ann Surg Oncol 6:790–796

20.

Witkamp AJ, de Bree E, Kaag MM et al (2001) Extensive surgical cytoreduction and intraoperative hyperthermic intraperitoneal chemotherapy in patients with pseudomyxoma peritonei. Br J Surg 88:458–463CrossRefPubMed

21.

Culliford AT, Brooks AD, Sharma S et al (2003) Surgical debulking and intraperitoneal chemotherapy for established peritoneal metastases from colon and appendix cancer. Ann Surg Oncol 8:787–795CrossRef

22.

Jacquet P, Stephens AD, Averbach AM et al (1996) Analysis of morbidity and mortality in 60 patients with peritoneal carcinomatosis treated by cytoreductive surgery and heated intraoperative intraperitoneal chemotherapy. Cancer 77:2622–2629CrossRefPubMed

23.

Zoetmulder FAN, Sugarbaker PH (1996) Patterns of failure following treatment of pseudomyxoma peritonei of appendiceal origin. Eur J Cancer 32A:1727–1733CrossRefPubMed

24.

Hinson FL, Ambrose NS (1998) Pseudomyxoma peritonei. Br J Surg 85:1332–1339CrossRefPubMed

25.

Moran BJ, Cecil TD (2003) The etiology, clinical presentation, and management of pseudomyxoma peritonei. Surg Oncol Clin N Am 12:585–603PubMed

26.

McQuellon RPO, Loggie BW, Fleming RA et al (2001) Quality of life after intraperitoneal hyperthermic chemotherapy (IHPC) for peritoneal carcinomatosis. Eur J Surg Oncol 27:65–73CrossRefPubMed

27.

McQuellon RP, Loggie BW, Lehman AB et al (2003) Long-term survivorship and quality of life after cytoreductive surgery plus intraperitoneal hyperthermic chemotherapy for peritoneal carcinomatosis. Ann Surg Oncol 10:155–162CrossRefPubMed

28.

Bryant J, Clegg AJ, Sidhu MK, Brodin H, Royle P, Davidson P (2004) Clinical effectiveness and costs of the Sugarbaker procedure for the treatment of pseudomyxoma peritonei. Health Technol Assess 8:1–54CrossRef

Title: Cytoreductive surgery and intraperitoneal chemotherapy for pseudomyxoma peritonei
Authors: Z. Güner
U. Schmidt
M. H. Dahlke
H. J. Schlitt
J. Klempnauer
P. Piso
Publication date: 01-03-2005
Publisher: Springer-Verlag
Published in: International Journal of Colorectal Disease / Issue 2/2005
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-004-0648-7

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Cytoreductive surgery and intraperitoneal chemotherapy for pseudomyxoma peritonei

Abstract

Background and aims

Patients and methods

Results

Conclusions

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Abstract

Background and aims

Patients and methods

Results

Conclusions

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