Survival after complete cytoreductive surgery and HIPEC for extensive pseudomyxoma peritonei.
INTRODUCTION
The optimal treatment for pseudomyxoma peritonei (PMP) combines complete cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC). Yet, achieving CRS is challenging in the case of extensive involvement of the peritoneal cavity and the survival benefit in this setting remains uncertain. The present study evaluated the surgical outcomes according to the peritoneal extent.


METHODS
Between 1992 and 2014, 245 patients underwent CRS and HIPEC for PMP in our institution. Their characteristics were reviewed using a prospective database. Extensive PMP was defined as a peritoneal cancer index (PCI) ≥ 28. Sixty-one patients with extensive PMP were compared to 184 with non-extensive PMP.


RESULTS
Severe complications were more frequent in the extensive group (46% vs. 23%, p < 0.001) but the post-operative mortality was not significantly different (8% vs. 3%, p = 0.1). The 5-year disease-free survival reached 45% in the extensive and 78% in the non-extensive group (p < 0.0001). The 5-year overall survival was 70% and 90% in the extensive and non-extensive group respectively (p < 0.021).


CONCLUSION
CRS with HIPEC offers prolonged survival even in the case of extensive PMP. Because of the high rate of surgical morbidity in the extensive group, patients should be carefully selected.
['Benhaim|Léonor|L|', 'Faron|Matthieu|M|', 'Gelli|Maximiliano|M|', 'Sourrouille|Isabelle|I|', 'Honoré|Charles|C|', 'Delhorme|Jean-Baptiste|JB|', 'Elias|Dominique|D|', 'Goere|Diane|D|']
D010478:Chemotherapy, Cancer, Regional Perfusion D003131:Combined Modality Therapy D065426:Cytoreduction Surgical Procedures D005260:Female D005500:Follow-Up Studies D006801:Humans D006979:Hyperthermia, Induced D008207:Lymphatic Metastasis D008297:Male D008875:Middle Aged D010534:Peritoneal Neoplasms D011379:Prognosis D011446:Prospective Studies D011553:Pseudomyxoma Peritonei D012189:Retrospective Studies D015996:Survival Rate
Surgery HIPEC PMP Peritoneal carcinomatosis Prognostic factors