title: Can a Benefit be Expected from Surgical Debulking of Unresectable Pseudomyxoma Peritonei?
abstract: OBJECTIVE
  This study evaluated the role of surgical debulking in improving pseudomyxoma peritonei (PMP)-related symptoms if complete cytoreductive surgery (CCRS) of huge PMP is unachievable.
  
  
  METHODS
  This was a retrospective analysis of a prospective database of all patients in our tertiary care center treated for PMP between 1992 and 2014. All cases of surgical debulking in patients scheduled for CCRS that proved unachievable during the operation were selected for the present study.
  
  
  RESULTS
  Among the 338 patients operated on for PMP, 39 (11.5 %) had undergone surgical debulking because CCRS was unachievable. All of these patients were symptomatic before surgery, and the median PCI was 32 (5-39). More than 80 % of the disease burden was resected in 23 patients (59 %). Mortality and major morbidity rates were 2.5 and 23 %, respectively. After debulking surgery, symptoms gradually subsided over a median time of 23 months and 50 % of the patients no longer experienced PMP-related symptoms after a median follow-up of 24.5 months. After a median follow-up of 46.4 months (range 3-120), median overall (OS) and progression-free (PFS) survival times were 55.5 and 20 months, respectively. Five-year OS and PFS rates were 46 and 11 %, respectively.
  
  
  CONCLUSIONS
  Aggressive debulking surgery in case of unachievable CCRS for huge PMP can offer prolonged relief of PMP-related symptoms and long-term survival, in experienced centers that are able to be sufficiently aggressive to resect the major part of the disease, and conservative enough to achieve low mortality and good quality of life.
authors.affiliation: Department of Surgical Oncology, Gustave Roussy Cancer Campus, Grand Paris, Villejuif Cedex, France.
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Delhorme
authors.affiliation: Department of Surgical Oncology, Gustave Roussy Cancer Campus, Grand Paris, Villejuif Cedex, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Elias
authors.affiliation: Department of Surgical Oncology, Gustave Roussy Cancer Campus, Grand Paris, Villejuif Cedex, France.
authors.forename: Sharmini
authors.initials: S
authors.lastname: Varatharajah
authors.affiliation: Department of Surgical Oncology, Gustave Roussy Cancer Campus, Grand Paris, Villejuif Cedex, France.
authors.forename: Léonor
authors.initials: L
authors.lastname: Benhaim
authors.affiliation: Department of Surgical Oncology, Gustave Roussy Cancer Campus, Grand Paris, Villejuif Cedex, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Dumont
authors.affiliation: Department of Surgical Oncology, Gustave Roussy Cancer Campus, Grand Paris, Villejuif Cedex, France.
authors.forename: Charles
authors.initials: C
authors.lastname: Honoré
authors.affiliation: Department of Surgical Oncology, Gustave Roussy Cancer Campus, Grand Paris, Villejuif Cedex, France. diane.goere@gustaveroussy.fr.
authors.forename: Diane
authors.initials: D
authors.lastname: Goéré
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003131:Combined Modality Therapy; D065426:Cytoreduction Surgical Procedures; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006979:Hyperthermia, Induced; D007274:Injections, Intraperitoneal; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009369:Neoplasms / Q000473:pathology / Q000628:therapy*; D010534:Peritoneal Neoplasms / Q000556:secondary / Q000601:surgery*; D011379:Prognosis; D011446:Prospective Studies; D011553:Pseudomyxoma Peritonei / Q000473:pathology / Q000601:surgery*; D011788:Quality of Life; D012189:Retrospective Studies; D015996:Survival Rate