Operability and early outcome in 48 Irish patients with peritoneal malignancy treated by surgery and intraperitoneal chemotherapy in a specialized centre.
BACKGROUND
In selected cases of peritoneal malignancy a novel approach of complete macroscopic tumour removal by extensive surgical cytoreduction, combined with intraperitoneal chemotherapy, provides a possibility of cure. The experience with 48 consecutive Irish cases undergoing laparotomy in a specialized centre is reported.


METHODS
A subset of 48 Irish patients out of a total of 120 cases with peritoneal malignancy underwent surgery between September 1999 and March 2011 in an English National referral centre. Overall 37/48 (77%) had appendiceal mucinous tumours with pseudomyxoma peritonei type syndrome. The treatment strategy involved macroscopic complete tumour removal (complete cytoreduction) combined with intra-operative, intraperitoneal chemotherapy.


RESULTS
Overall 30/48 (62.5%) had complete cytoreduction, 15/48 (31.3%) had major debulking and 3 (4.2%) had laparotomy and biopsy only. The median (range) operating time in hours was 9.8 (4.8-16) in the 30 who had complete cytoreduction compared with 6.3 (4.5-11) in the 15 who had debulking (p = 0.019). There was no post-operative mortality. Overall five year survival for the complete tumour removal group was 66% compared with 12% for those only amenable to major debulking.


CONCLUSIONS
This novel strategy of cytoreduction combined with intraperitoneal chemotherapy is effective in selected patients with peritoneal malignancy. The complex surgery is particularly effective for appendiceal tumours and provides the only possibility of cure in this challenging disease.
Pseudomyxoma Peritonei Centre, Basingstoke and North Hampshire Foundation Trust Hospital, Aldermaston Road, Basingstoke, Hampshire RG24 9NA, UK.
Caitriona
C
Crawford
Ahmed Zia
AZ
Janjua
Kandiah
K
Chandrakumaran
Brendan
B
Moran
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007494:Ireland / Q000453:epidemiology; D007813:Laparotomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D013531:Surgicenters / Q000706:statistics & numerical data*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
D000970:Antineoplastic Agents