Treating pseudomyxoma peritonei without heated intraperitoneal chemotherapy--a first look in New Zealand.

ABSTRACT

BACKGROUND: Pseudomyxoma peritonei is a condition characterised by dissemination of mucin-producing neoplastic cells throughout the peritoneal cavity. There are two pathological subsets, disseminated peritoneal adenomucinosis and peritoneal mucinosis carcinomatosis. Once a lethal disease, cytoreductive surgery combined with heated intraperitoneal chemotherapy (HIPEC) is challenging debulking as the standard of care. OBJECTIVE: We present the first case series detailing the postoperative morbidity, mortality and survival outcomes of patients treated for pseudomyxoma peritonei by cytoreductive surgery without heated intraperitoneal chemotherapy by a single surgeon. DESIGN: Wellington Hospital clinical databases were retrospectively searched. Inclusion criteria were a diagnosis of pseudomyxoma peritonei with a major cytoreductive operation with the intention of complete cytoreductive clearance. Exclusion criteria were palliative debulking operations and patient records not available for analysis. RESULTS: 25 patients underwent cytoreductive surgery between June 1999 and July 2011. Mean follow-up was 43.5 months (1.5-138). Histological classification was DPAM for 13/25 and PMCA for 12/25. Complete cytoreduction (CC-0 and CC-1) was achieved in 21/25 patients. There was no 30 day mortality following primary cytoreduction. Six patients underwent subsequent debulking/cytoreductive surgery; one patient died following repeat surgery. Clavien-Dindo grade 3 or 4 complications occurred in 7/25 patients. Combined 5-year survival was 64%, 92% for DPAM and 33% for PMCA. CONCLUSION: Cytoreductive surgery alone may result in comparable survival outcomes to those achieved with combined surgery and HIPEC in selected patients, especially for patients with DPAM.