title: Right hemicolectomy is not routinely indicated in pseudomyxoma peritonei.
abstract: Pseudomyxoma peritonei (PMP) is primarily the result of a ruptured mucinous appendix neoplasm (MAN). Often MAN is lumped with but biologically distinct from intestinal appendiceal adenocarcinoma. Nodal and systemic dissemination are rare with the peritoneal cavity being the primary  site of recurrence. Routine performance of right hemicolectomy (RHC) for PMP/MAN has been extensively debated without consensus. Our objective was to ascertain whether RHC has a survival advantage over appendectomy. We hypothesize if RHC is mandatory, then increased tumor recurrence and mortality  should be observed in appendectomy only. Retrospective chart review was carried out in patients with tumors that met the Ronnett classification for PMP/MAN. Demographics, tumor grade, extent, recurrence, and progression were recorded. We report the rate of nodal involvement/recurrence in patients  treated with RHC versus appendectomy as well as the rate of systemic and peritoneal recurrence and survival. Multivariate logistic regression was done to identify factors that impact survival. Of 120 patients, 48 had appendectomy and 72 had RHC. Seven per cent of patients undergoing  RHC had positive lymph nodes and no nodal failures (0%) in patients undergoing appendectomy. Appendectomy versus RHC recurrence rates (21 vs. 28%, P = 0.12) and death resulting from disease (8 vs. 22%, P = 0.27) were similar. Logistic regression revealed  that the type of surgery had no impact on recurrence and mortality, only optimal resection score and performance status. There was no difference in tumor recurrence or survival based on treatment by appendectomy or RHC. Performance status and complete cytoreduction are the only factors associated  with survival. Lymph node involvement is rare and selective RHC is safe in PMP/MAN.
authors.affiliation: Department of Surgery, Creighton Cancer Center, Creighton University, Omaha, NE 68198-4030, USA. jfosterm@unmc.edu
authors.forename: Jason M
authors.initials: JM
authors.lastname: Foster
authors.forename: Prateek K
authors.initials: PK
authors.lastname: Gupta
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Carreau
authors.forename: Travis E
authors.initials: TE
authors.lastname: Grotz
authors.forename: Joseph V
authors.initials: JV
authors.lastname: Blas
authors.forename: Zoran
authors.initials: Z
authors.lastname: Gatalica
authors.forename: Swapan
authors.initials: S
authors.lastname: Nath
authors.forename: Brian W
authors.initials: BW
authors.lastname: Loggie
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001062:Appendectomy / Q000379:methods*; D003082:Colectomy / Q000379:methods*; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D011553:Pseudomyxoma Peritonei / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology