title: Pseudomyxoma peritonei treated by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: results from a single centre.
abstract: BACKGROUND
  Pseudomyxoma peritonei (PMP) is a rare, slowly progressive disease whose prognosis depends primarily on the completeness of cytoreduction. The value of intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) and of additional factors predicting long-term outcome and disease-free survival (DFS) remains poorly understood. This study aims to analyse survival rates and prognostic factors in patients undergoing maximal cytoreduction and HIPEC.
  
  
  METHODS
  Thirty patients were selected from a prospective database of records for patients undergoing cytoreduction and HIPEC with mitomycin C or paclitaxel. Overall survival (OS), DFS, and the prognostic factors influencing them, were examined using multivariate analysis.
  
  
  RESULTS
  Median follow-up was 44 months (range, 8-144). Histological classification of PMPs was DPAM in 6/30 of cases, PMCA-I in 10/30 and PMCA in 14/30. Complete cytoreduction (CC-0 and CC-1) was achieved in 28/30 of patients and CC-2 in 2/30. Median OS was 111 months (range 0-230) and five-year OS rate was 67%. Median DFS was 53.5 months (range 0-120) and 5-year DFS rate was 44%. Incomplete cytoreduction, lymph node involvement and PCI>20 were associated with poor prognosis for OS, while lymph node involvement, elevated CA-125 levels, unfavourable histology and previous chemotherapy were associated with poor outcomes for DFS. There was morbidity of Grade 3 or higher in 9/30. Post-operative mortality occurred in 1 case.
  
  
  CONCLUSIONS
  Cytoreduction plus peritonectomy procedures combined with HIPEC is a safe treatment and could improve survival rates. Since the optimal cytoreduction is the primary prognostic factor, patients should be centralised under the care of experienced teams.
authors.affiliation: Department of General Surgery, Unit of Surgical Oncology, Hospital Universitario Reina Sofía, Córdoba, Spain.
authors.forename: Álvaro
authors.initials: Á
authors.lastname: Arjona-Sánchez
authors.forename: Francisco C
authors.initials: FC
authors.lastname: Muñoz-Casares
authors.forename: Sebastián
authors.initials: S
authors.lastname: Rufián-Peña
authors.forename: Rafael
authors.initials: R
authors.lastname: Díaz-Nieto
authors.forename: Ángela
authors.initials: Á
authors.lastname: Casado-Adam
authors.forename: María J
authors.initials: MJ
authors.lastname: Rubio-Pérez
authors.forename: Rosa
authors.initials: R
authors.lastname: Ortega-Salas
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage*; D010478:Chemotherapy, Cancer, Regional Perfusion; D006801:Humans; D006979:Hyperthermia, Induced; D016685:Mitomycin / Q000008:administration & dosage; D017239:Paclitaxel / Q000008:administration & dosage; D010534:Peritoneal Neoplasms / Q000188:drug therapy* / Q000601:surgery*; D011553:Pseudomyxoma Peritonei / Q000188:drug therapy* / Q000601:surgery*
chemical_list: D000970:Antineoplastic Agents; D016685:Mitomycin; D017239:Paclitaxel