title: Treating pseudomyxoma peritonei without heated intraperitoneal chemotherapy--a first look in New Zealand.
abstract: BACKGROUND
  Pseudomyxoma peritonei is a condition characterised by dissemination of mucin-producing neoplastic cells throughout the peritoneal cavity. There are two pathological subsets, disseminated peritoneal adenomucinosis and peritoneal mucinosis carcinomatosis. Once a lethal disease, cytoreductive surgery combined with heated intraperitoneal chemotherapy (HIPEC) is challenging debulking as the standard of care.
  
  
  OBJECTIVE
  We present the first case series detailing the postoperative morbidity, mortality and survival outcomes of patients treated for pseudomyxoma peritonei by cytoreductive surgery without heated intraperitoneal chemotherapy by a single surgeon.
  
  
  METHODS
  Wellington Hospital clinical databases were retrospectively searched. Inclusion criteria were a diagnosis of pseudomyxoma peritonei with a major cytoreductive operation with the intention of complete cytoreductive clearance. Exclusion criteria were palliative debulking operations and patient records not available for analysis.
  
  
  RESULTS
  25 patients underwent cytoreductive surgery between June 1999 and July 2011. Mean follow-up was 43.5 months (1.5-138). Histological classification was DPAM for 13/25 and PMCA for 12/25. Complete cytoreduction (CC-0 and CC-1) was achieved in 21/25 patients. There was no 30 day mortality following primary cytoreduction. Six patients underwent subsequent debulking/cytoreductive surgery; one patient died following repeat surgery. Clavien-Dindo grade 3 or 4 complications occurred in 7/25 patients. Combined 5-year survival was 64%, 92% for DPAM and 33% for PMCA.
  
  
  CONCLUSIONS
  Cytoreductive surgery alone may result in comparable survival outcomes to those achieved with combined surgery and HIPEC in selected patients, especially for patients with DPAM.
authors.affiliation: Wellington Hospital, Riddiford Street, Newtown, Wellington 6021, New Zealand. BRLWheeler@gmail.com.
authors.forename: Benjamin R
authors.initials: BR
authors.lastname: Wheeler
authors.forename: Sumeet K
authors.initials: SK
authors.lastname: Reddy
authors.forename: Diane
authors.initials: D
authors.lastname: Kenwright
authors.forename: John P
authors.initials: JP
authors.lastname: Keating
mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000401:mortality / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D061646:Operative Time; D010534:Peritoneal Neoplasms / Q000401:mortality / Q000601:surgery*; D010537:Peritoneum / Q000601:surgery*; D011183:Postoperative Complications; D011553:Pseudomyxoma Peritonei / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome