title: Upfront compared to delayed cytoreductive surgery and perioperative intraperitoneal chemotherapy for pseudomyxoma peritonei is associated with considerably lower perioperative morbidity and recurrence rate.
abstract: BACKGROUND
  Cytoreductive surgery (CRS) combined with perioperative intraperitoneal chemotherapy (PIC) is a recognized management strategy for pseudomyxoma peritonei. We seek to evaluate the outcomes of patients treated upfront with CRS PIC compared to patients undergoing delayed CRS PIC as salvage or treatment for recurrences after initial debulking surgery.
  
  
  METHODS
  Retrospective analysis of patients with low-grade pseudomyxoma peritonei treated within our institution were stratified according to upfront versus delayed CRS PIC after intial debulking surgery. Survival was analyzed using the Kaplan-Meier method and compared using the log-rank test.
  
  
  RESULTS
  Of 83 patients treated, 35 patients (42%) underwent upfront and 48 patients (58%) underwent delayed CRS PIC. The peritoneal cancer index (P = 0.048), amount of blood transfusion intraoperatively (P = 0.003) and duration of operation (P = 0.007) was lesser in the upfront compared to delayed group. Upfront treatment confers 5-year recurrence-free survival benefit (77% vs 37%; P = 0.011) and 10-year overall survival benefit (67% vs 35%; P = 0.054) over delayed treatment.
  
  
  CONCLUSIONS
  Upfront CRS PIC seems to confer beneficial perioperative outcomes and lower recurrence rates over delayed CRS PIC. Early referral to centralized treatment centers would seem to be a reasonable strategy to improve outcomes.
authors.affiliation: UNSW Department of Surgery, Cancer Care Centre, St George Hospital, Kogarah, Sydney, Australia.
authors.forename: Terence C
authors.initials: TC
authors.lastname: Chua
authors.forename: Winston
authors.initials: W
authors.lastname: Liauw
authors.forename: Jing
authors.initials: J
authors.lastname: Zhao
authors.forename: David L
authors.initials: DL
authors.lastname: Morris
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000379:methods*; D016009:Chi-Square Distribution; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007263:Infusions, Parenteral; D053208:Kaplan-Meier Estimate; D007813:Laparotomy / Q000379:methods; D008297:Male; D008937:Mitomycins / Q000008:administration & dosage; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000473:pathology; D009367:Neoplasm Staging; D019990:Perioperative Care / Q000379:methods; D010534:Peritoneal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D010537:Peritoneum / Q000187:drug effects / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D011379:Prognosis; D011553:Pseudomyxoma Peritonei / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D008937:Mitomycins; C046000:mitomycin A