Aj. Witkamp et al., Extensive surgical cytoreduction and intraoperative hyperthermic intraperitoneal chemotherapy in patients with pseudomyxoma peritonei, BR J SURG, 88(3), 2001, pp. 458-463
Background: Pseudomyxoma peritonei remains a fatal disease. However, extens
ive surgical cytoreduction combined with intraoperative heated intraperiton
eal chemotherapy (HIPEC) has recently emerged as a new treatment modality,
which might improve survival.
Methods: Patients underwent treatment if the tumour appeared to be technica
lly resectable on preoperative abdominal computed tomography and there were
no distant metastases. After aggressive surgical cytoreduction, HIPEC with
the administration of mitomycin C was performed for 90 min. Depending on h
istological grading, patients received adjuvant 5-fluorouracil and leucovor
in therapy.
Results: Forty-six patients were treated. Optimal surgical cytoreduction wa
s obtained in 40 patients. Postoperative surgical complications occurred in
18 patients. Four patients died as a direct result of the treatment. Bone
marrow suppression due to mitomycin C toxicity occurred in 22 patients. The
re was no other major toxicity related to the HIPEC procedure. After a medi
an follow-up of 12 months, 40 patients are alive, eight of whom have proven
recurrence. The actuarial survival rate (Kaplan-Meier) at 3 years was 81 p
er cent.
Conclusion: These results confirm that extensive surgery combined with HIPE
C is feasible in patients with pseudomyxoma peritonei and that improved lon
g-term survival might be achieved.