A C Lord1, O Shihab2, K Chandrakumaran2, F Mohamed2, T D Cecil2, B J Moran2. 1. Peritoneal Malignancy Unit, Basingstoke and North Hampshire Hospital Aldermaston Road, Basingstoke, Hampshire RG24 9NA, UK. Electronic address: amycharlottelord@gmail.com. 2. Peritoneal Malignancy Unit, Basingstoke and North Hampshire Hospital Aldermaston Road, Basingstoke, Hampshire RG24 9NA, UK.
Abstract
BACKGROUND: Pseudomyxoma peritonei (PMP) usually originates from perforated mucinous appendiceal tumours and may present unexpectedly at surgery, or be suspected at cross sectional imaging. The optimal treatment involves macroscopic tumour removal by cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC). The 10-year Kaplan-Meier predicted disease-free survival is 61%. Some patients with recurrence are amenable to further CRS and HIPEC. AIM: To evaluate the outcomes of re-do surgery in a large single centre series of reoperation for recurrence of peritoneal surface malignancy. METHOD: Retrospective analysis of prospective database of 752 patients undergoing CRS for perforated appendiceal tumours analysed. Routine follow up involved annual CT scans and serum tumour marker measurement. The survival and recurrence in the 512/752 (68.1%) who had complete cytoreduction between March 1994 and January 2012 was calculated by Kaplan-Meier univariate analysis. RESULTS: Overall 137/512 (26.4%) developed recurrence and of those 35/137 (25.5%) underwent repeat surgery. Complete tumour removal was again achieved in 20/35 (57.1%). There were no postoperative deaths and no significant difference in early postoperative complications and length of stay compared to primary CRS surgery. The 5-year survival in the 375 without recurrence, the 35 who had re-do surgery and the 102 who had recurrence with no surgery was 90.9%, 79.0% and 64.5% respectively. CONCLUSION: Approximately one in four patients develops recurrence after complete CRS and HIPEC for PMP of appendiceal origin. Selected patients can undergo salvage surgery with good outcomes.
BACKGROUND:Pseudomyxoma peritonei (PMP) usually originates from perforated mucinous appendiceal tumours and may present unexpectedly at surgery, or be suspected at cross sectional imaging. The optimal treatment involves macroscopic tumour removal by cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC). The 10-year Kaplan-Meier predicted disease-free survival is 61%. Some patients with recurrence are amenable to further CRS and HIPEC. AIM: To evaluate the outcomes of re-do surgery in a large single centre series of reoperation for recurrence of peritoneal surface malignancy. METHOD: Retrospective analysis of prospective database of 752 patients undergoing CRS for perforated appendiceal tumours analysed. Routine follow up involved annual CT scans and serum tumour marker measurement. The survival and recurrence in the 512/752 (68.1%) who had complete cytoreduction between March 1994 and January 2012 was calculated by Kaplan-Meier univariate analysis. RESULTS: Overall 137/512 (26.4%) developed recurrence and of those 35/137 (25.5%) underwent repeat surgery. Complete tumour removal was again achieved in 20/35 (57.1%). There were no postoperative deaths and no significant difference in early postoperative complications and length of stay compared to primary CRS surgery. The 5-year survival in the 375 without recurrence, the 35 who had re-do surgery and the 102 who had recurrence with no surgery was 90.9%, 79.0% and 64.5% respectively. CONCLUSION: Approximately one in four patients develops recurrence after complete CRS and HIPEC for PMP of appendiceal origin. Selected patients can undergo salvage surgery with good outcomes.
Authors: Adriana C Gamboa; Mohammad Y Zaidi; Rachel M Lee; Shelby Speegle; Jeffrey M Switchenko; Joseph Lipscomb; Jordan M Cloyd; Ahmed Ahmed; Travis Grotz; Jennifer Leiting; Keith Fournier; Andrew J Lee; Sean Dineen; Benjamin D Powers; Andrew M Lowy; Nikhil V Kotha; Callisia Clarke; T Clark Gamblin; Sameer H Patel; Tiffany C Lee; Laura Lambert; Ryan J Hendrix; Daniel E Abbott; Kara Vande Walle; Kelly Lafaro; Byrne Lee; Fabian M Johnston; Jonathan Greer; Maria C Russell; Charles A Staley; Shishir K Maithel Journal: Ann Surg Oncol Date: 2019-06-26 Impact factor: 5.344
Authors: Joel M Baumgartner; Thomas G Kwong; Grace L Ma; Karen Messer; Kaitlyn J Kelly; Andrew M Lowy Journal: Ann Surg Oncol Date: 2015-12-17 Impact factor: 5.344