Extensive surgical cytoreduction and intraoperative hyperthermic intraperitoneal chemotherapy in patients with pseudomyxoma peritonei.
BACKGROUND
Pseudomyxoma peritonei remains a fatal disease. However, extensive surgical cytoreduction combined with intraoperative heated intraperitoneal chemotherapy (HIPEC) has recently emerged as a new treatment modality, which might improve survival.


METHODS
Patients underwent treatment if the tumour appeared to be technically 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 histological grading, patients received adjuvant 5-fluorouracil and leucovorin therapy.


RESULTS
Forty-six patients were treated. Optimal surgical cytoreduction was 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. There was no other major toxicity related to the HIPEC procedure. After a median 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 per cent.


CONCLUSIONS
These results confirm that extensive surgery combined with HIPEC is feasible in patients with pseudomyxoma peritonei and that improved long-term survival might be achieved.
Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
A J
AJ
Witkamp
E
E
de Bree
M M
MM
Kaag
G W
GW
van Slooten
F
F
van Coevorden
F A
FA
Zoetmulder
D000328:Adult; D000368:Aged; D000903:Antibiotics, Antineoplastic / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant / Q000379:methods; D010478:Chemotherapy, Cancer, Regional Perfusion; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods*; D007262:Infusions, Intravenous; D007275:Injections, Intravenous; D007902:Length of Stay; D002955:Leucovorin / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000627:therapeutic use*; D009364:Neoplasm Recurrence, Local; D010534:Peritoneal Neoplasms / Q000188:drug therapy* / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D011553:Pseudomyxoma Peritonei / Q000188:drug therapy* / Q000601:surgery*; D012086:Reoperation; D016896:Treatment Outcome
D000903:Antibiotics, Antineoplastic; D016685:Mitomycin; D002955:Leucovorin; D005472:Fluorouracil