Kim Govaerts1, K Chandrakumaran2, Norman J Carr2, Thomas D Cecil2, Sanjeev Dayal2, Faheez Mohamed2, Andrew Thrower2, Brendan J Moran3. 1. Peritoneal Malignancy Institute, Basingstoke, North Hampshire Hospital, Aldermaston Road, Basingstoke, Hampshire, RG24 9NA, UK. Electronic address: kim@gomi.eu. 2. Peritoneal Malignancy Institute, Basingstoke, North Hampshire Hospital, Aldermaston Road, Basingstoke, Hampshire, RG24 9NA, UK. 3. Peritoneal Malignancy Institute, Basingstoke, North Hampshire Hospital, Aldermaston Road, Basingstoke, Hampshire, RG24 9NA, UK. Electronic address: Brendan.Moran@hhft.nhs.uk.
Abstract
AIM: Pseudomyxoma peritonei (PMP) is an uncommon malignancy, generally originating from a ruptured epithelial tumour of the appendix. Despite successful cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), some patients recur. Currently there are no guidelines on the methods, frequency and intensity of follow-up. METHODS: Between 1994 and 2016, 1070 patients underwent surgery for a perforated epithelial tumour of the appendix, predominantly with PMP. Overall (OS) and Disease Free Survival (DFS) were documented by annual CT scanning and evaluated according to the Kaplan-Meier method. The influence of histological differentiation was investigated. RESULTS: Overall, 775/1070 (72%) had complete cytoreductive surgery (CCRS) and HIPEC. Histological classification was low grade PMP in 615 (79.4%), high grade PMP in 134 (17.3%) and adenocarcinoma in 26 (3.4%). DFS and OS were significantly worse for high grade disease, with the steepest decline for both in the first three years. DFS curves, for low as well as high grade PMP, levelled off at year 6 at approximately 60% and 20% respectively. Thereafter there were few recurrences in either group. CONCLUSION: Annual CT of the abdomen and pelvis in the first six years appears to be adequate follow-up for low grade PMP. In high grade PMP, additional imaging of the chest and more frequent surveillance, during the first three years postoperatively, may detect recurrent disease earlier. From year 6 on, reduced frequency of follow-up is proposed, independent of the histology. This long-term follow-up in a large number of patients gives insight into tumour behavior after CCRS and HIPEC for PMP and guides intensity of surveillance.
AIM: Pseudomyxoma peritonei (PMP) is an uncommon malignancy, generally originating from a ruptured epithelial tumour of the appendix. Despite successful cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), some patients recur. Currently there are no guidelines on the methods, frequency and intensity of follow-up. METHODS: Between 1994 and 2016, 1070 patients underwent surgery for a perforated epithelial tumour of the appendix, predominantly with PMP. Overall (OS) and Disease Free Survival (DFS) were documented by annual CT scanning and evaluated according to the Kaplan-Meier method. The influence of histological differentiation was investigated. RESULTS: Overall, 775/1070 (72%) had complete cytoreductive surgery (CCRS) and HIPEC. Histological classification was low grade PMP in 615 (79.4%), high grade PMP in 134 (17.3%) and adenocarcinoma in 26 (3.4%). DFS and OS were significantly worse for high grade disease, with the steepest decline for both in the first three years. DFS curves, for low as well as high grade PMP, levelled off at year 6 at approximately 60% and 20% respectively. Thereafter there were few recurrences in either group. CONCLUSION: Annual CT of the abdomen and pelvis in the first six years appears to be adequate follow-up for low grade PMP. In high grade PMP, additional imaging of the chest and more frequent surveillance, during the first three years postoperatively, may detect recurrent disease earlier. From year 6 on, reduced frequency of follow-up is proposed, independent of the histology. This long-term follow-up in a large number of patients gives insight into tumour behavior after CCRS and HIPEC for PMP and guides intensity of surveillance.
Authors: Mohammad Y Zaidi; Rachel M Lee; Adriana C Gamboa; Shelby Speegle; Jordan M Cloyd; Charles Kimbrough; Travis Grotz; Jennifer Leiting; Keith Fournier; Andrew J Lee; Sean Dineen; Sophie Dessureault; Kaitlyn J Kelly; Nikhil V Kotha; Callisia Clarke; T Clark Gamblin; Sameer H Patel; Tiffany C Lee; Ryan J Hendrix; Laura Lambert; Sean Ronnekleiv-Kelly; Courtney Pokrzywa; Andrew M Blakely; Byrne Lee; Fabian M Johnston; Nadege Fackche; Maria C Russell; Shishir K Maithel; Charles A Staley Journal: Ann Surg Oncol Date: 2019-10-10 Impact factor: 5.344
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: L Martín Román; P Lozano; D Baratti; S Kusamura; M Deraco; W Vásquez; L González Bayón Journal: Ann Surg Oncol Date: 2022-07-25 Impact factor: 4.339