title: Outcome and surgical strategy in critical sites in cases of psuedomyxoma peritonei.
abstract: BACKGROUND
  For a long time peritoneal neoplasms were considered beyond surgical intervention and beyond cure, till the concept of cytoreductive surgery (CRS) and adjuvant hyperthermic intraperitoneal chemotherapy (HIPEC) was introduced. However this surgical intervention is technically demanding and associated with considerable postoperative morbidity.
  
  
  OBJECTIVE
  To describe the surgical strategy in resection of critical sites loaded by heavy tumor deposits and to evaluate short and long term results of CRS and HIPEC, in a cohort of Egyptian patients with pseudomyxoma peritonei (PMP) from appendiceal origin.
  
  
  METHODS
  21 patients with PMP, age ranged from 40 to 63years, 12 males and 9 females. All were recruited from the department of surgery at the National Cancer Institute (NCI), Cairo University over the period from February 2011 to February 2016. They were subjected to CRS and HIPEC with mitomycin-C.
  
  
  RESULTS
  The median peritoneal carcinoma index (PCI) was 22 (range: 10-39). Optimal cytoreduction (CCR-0/1) was achieved in 19 patients (90.4%) of whom 17 patients (80.9%) had a complete cytoreduction (CCR-0). The median follow up period was 51.5months (range: 0.07-82.3months). The cumulative overall survival was 85.7% while the cumulative disease free survival was 76.9%.
  
  
  CONCLUSIONS
  To the best of our knowledge, this is the first study reporting five years postoperative outcome of CRS and HIPEC in Egyptian patients with PMP from appendiceal origin. Our results support that although technically demanding this treatment modality is safe and associated with favorable outcome.
authors.affiliation: Surgical Oncology Department, National Cancer Institute, Cairo University, Egypt. Electronic address: drbarbary@yahoo.com.
authors.forename: Ahmed Mostafa Ahmed
authors.initials: AM
authors.lastname: Mahmoud
authors.affiliation: Medical Oncology Department, National Cancer Institute, Cairo University, Egypt.
authors.forename: Marwa Mahmoud
authors.initials: MM
authors.lastname: Hussein
authors.affiliation: Cancer Epidemiology and Biostatistics Department, National Cancer Institute, Cairo University, Egypt.
authors.forename: Manar Mohamed
authors.initials: MM
authors.lastname: Moneer
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D003131:Combined Modality Therapy; D065426:Cytoreduction Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D018572:Disease-Free Survival; D004534:Egypt; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D010534:Peritoneal Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000473:pathology*; D011553:Pseudomyxoma Peritonei / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D016685:Mitomycin
keywords: Cytoreductive surgery; HIPEC; Pseudomyxoma peritonei