title: Outcomes of cytoreductive surgery and HIPEC for pseudomyxoma peritonei of appendiceal origin from two Indian centers: A preliminary five-year experience.
abstract: OBJECTIVE
  To evaluate the short-term outcomes of patients of pseudomyxoma peritonei (PMP) of appendiceal origin treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) at two tertiary Indian centers.
  
  
  METHODS
  Data was prospectively collected from January 2011 to January 2016. Palliative procedures were excluded. HIPEC was performed by the coliseum technique using either a mitomycin or oxaliplatin-based regimen.
  
  
  RESULTS
  77 procedures were performed on 71 patients. The average time interval between diagnosis and CRS was 15.3 months. Of the tumors, 22.1% were high grade, 77.9% low grade and 24.6% intermediate grade. The median peritoneal carcinomatosis index (PCI) was 26 (<25 in 70.1% and >30 in 38.9%). Completeness of cytoreduction score (CCS)-1 was achieved in 75.3% (CC-0 in 42.9%). The mean number of bowel anastomoses was 1.1 and the mean number of organs resected per patient was 3.3. Of the 77 patients, 71% had resection of 3 or more organs and 50.6% had resection of 4 or more organs. Grade 3-4 complications occurred in 42.9% of the patients and the perioperative mortality was 5.2%. The projected 5-year overall survival (OS) was 62.3% and the 3-year disease-free survival (DFS) was 71% at a median follow up of 13 months.
  
  
  CONCLUSIONS
  CRS and HIPEC can be used to treat PMP with an acceptable morbidity and mortality in Indian patients. Lack of early referrals leads to a large portion of patients presenting with extensive disease and an inferior survival which should improve with increasing awareness about the procedure and its results.
authors.affiliation: Department of Surgical Oncology, Fortis Hospital, Bangalore, India.
authors.forename: Aditi
authors.initials: A
authors.lastname: Bhatt
authors.forename: Deepak
authors.initials: D
authors.lastname: Sheshadri
authors.forename: Garud
authors.initials: G
authors.lastname: Chandan
authors.forename: Veena
authors.initials: V
authors.lastname: Ramaswamy
authors.forename: Jeegeshwar
authors.initials: J
authors.lastname: Pandey
authors.forename: Nitin
authors.initials: N
authors.lastname: Bhorkar
authors.forename: Deepesh
authors.initials: D
authors.lastname: Agrawal
authors.forename: Sanket
authors.initials: S
authors.lastname: Mehta
mesh_terms: D001063:Appendiceal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D065426:Cytoreduction Surgical Procedures; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D007274:Injections, Intraperitoneal; D008297:Male; D010534:Peritoneal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D011553:Pseudomyxoma Peritonei / Q000401:mortality / Q000473:pathology / Q000628:therapy*