Cytoreductive surgery and peri-operative intraperitoneal chemotherapy as acurative approach to pseudomyxoma peritonei syndrome

Peritoneal carcinomatosis, regardless of primary tumour type, has always be en a lethal condition. Recently special treatments using cytoreductive surg ery with peritonectomy procedures combined with peri-operative intraperiton eal chemotherapy have resulted in long-term survival. Pseudomyxoma peritone i may be especially appropriate for these aggressive local regional treatme nts. All patients treated prior to 1999 are presented; patients left with gross residual disease after surgery were not given intraperitoneal chemotherapy, but were later treated with intravenous chemotherapy after cytoreduction. The intraperitoneal chemotherapy was given in the peri-operative period, st arting with mitomycin C. For patients whose pathology showed adenomucinosis , intraperitoneal chemotherapy was limited to treatment in the operating th eatre with heated mitomycin C. Patients with mucinous adenocarcinoma or pse udomyxoma/adenocarcinoma hybrid had, in addition to mitomycin C, 5 consecut ive days of intraperitoneal 5-fluorouracil. A complete cytoreduction was de fined as tumour nodules <2.5 mm in diameter remaining after surgery The his topathology categorized the patients as adenomucinosis, intermediate type, or mucinous carcinomatosis. A prior surgical score was used to estimate the extent of previous surgical procedures. The morbidity of treated patients was 27% and the mortality was 2.7%. In a multivariate analysis, prognostic factors for survival included the complet eness of cytoreduction (P<0.0001), the histopathological character of the a ppendix malignancy (P<0.001) and the extent of previous surgical interventi ons (P = 0.001). Patients with a complete cytoreduction and adenomucinosis by pathology had a 5-year survival of 86%; while hybrid pathology survival at 5 years was 50%. Incomplete cytoreduction had a 5-year survival of 20% a nd 0% at 10 years. Cytoreductive surgery and peri-operative intraperitoneal chemotherapy is th e current standard treatment for selected patients with peritoneal surface spread of appendiceal primary tumours. Similar strategies for other patient s with peritoneal surface malignancy such as peritoneal carcinomatosis from colon or gastric cancer, peritoneal sarcomatosis, or peritoneal mesothelio ma should be pursued. (C) 2001 Harcourt Publishers Ltd.