PATTERNS OF FAILURE FOLLOWING TREATMENT OF PSEUDOMYXOMA PERITONEI OF APPENDICEAL ORIGIN

Pseudomyxoma peritonei is a rare disease caused by a perforated adenom a of the appendix. It results in extensive accumulation of mucinous tu mour at specific locations within the abdomen and pelvis. The study wa s undertaken to examine patterns of recurrence in patients with grade I disease treated by cytoreductive surgery and early postoperative int raperitoneal chemotherapy. After a median followup of 1.9 years (range 0.5-7.4 years) 42 out of 118 patients had recurred. In 32 patients, d etailed information regarding the anatomical location of recurrent tum our from CT-scan and second-look laparotomy were available and these f orm the basis of this study. The volume of recurrent tumour was record ed at eight abdominal sites, the laparotomy scar and at suture lines. Patient, tumour and treatment factors were analysed for a possible rel ationship with the pattern of recurrence. With recurrence, true metast atic disease was observed in 3 patients and a distinctly higher grade of intraperitoneal tumour in another patient. Pleural spread of pseudo myxoma was found in 6 patients, always related to entering the pleural cavity during cytoreduction (P = 0.000031). Two abdominal sites consi stently had an increase in tumour deposits at re-operation as compared to the initial cytoreduction. Small bowel had large deposits at re-op eration in 17% versus 3% at initial cytoreduction and retroperitoneal surfaces 10% versus 0%. Recurrences were most frequent in the left sub hepatic/lesser omentum area (28%), while the right subdiaphragmatic ar ea (3%) was least involved. Pseudomyxoma peritonei recurrence in the l aparotomy scar was found in 15/29 patients (52%), significantly more f requent if tumour had been present at former laparotomy scars during c ytoreduction (P = 0.042). In 15/25 (60%) of patients, recurrences were found at suture lines. Differences in the completeness of cytoreducti on, inadequate distribution of intraperitoneal chemotherapy to upper a bdominal and small bowel surfaces, and entrapment of tumour within sut ure lines were thought to be causal factors consistent with this patte rn of recurrence. Consequences for future treatment strategies are dis cussed. Copyright (C) 1996 Published by Elsevier Science Ltd