Bertrand Trilling1, Alexandre Brind'Amour1, Raphael Hamad1, Jean-Francois Tremblay1, Pierre Dubé1, Andrew Mitchell2, Lucas Sidéris3. 1. Department of Surgery, Hôpital Maisonneuve-Rosemont, Université de Montréal, 5415 boul. de l'Assomption, Montréal, Québec, H1T 2M4, Canada. 2. Department of Pathology, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Canada. 3. Department of Surgery, Hôpital Maisonneuve-Rosemont, Université de Montréal, 5415 boul. de l'Assomption, Montréal, Québec, H1T 2M4, Canada. lucas.sideris@umontreal.ca.
Abstract
BACKGROUND: Complete cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is the only curative treatment for pseudomyxoma peritonei (PMP) arising from the appendix. High peritoneal carcinomatosis index (PCI) is associated with an increased risk of surgical complications. The objective of this study was to present the results of a planned two-step surgical strategy to decrease postoperative morbidity and improve resectability of patients with very high PCI. METHODS: All consecutive patients who underwent a planned two-step surgical approach for PMP between January 2012 and March 2020 were retrospectively included. This approach was offered for patients with low-grade PMP with PCI > 28 for which feasibility of a complete CRS in one operation was uncertain. The first surgery included a complete CRS of the inframesocolic compartment and omentectomy. HIPEC was delivered at the second surgery, after complete CRS of the supramesocolic compartment. Postoperative morbidity was assessed using the Clavien-Dindo classification and survival results were also collected. RESULTS: Eight patients underwent the two-step approach. The median PCI was 33 (29-39) and the median time between the two procedures was 111 days (90-212 days). One patient was deemed unresectable at the second surgery. The rate of major morbidity was 0% for the first step and 25% for the second step, with no mortality. Median follow-up was 53.8 months (3-73 months). CONCLUSION: A two-step surgical management for low-grade PMP patients with very high PCI is safe and feasible, with acceptable postoperative morbidity and no compromise on oncological outcomes.
BACKGROUND: Complete cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is the only curative treatment for pseudomyxoma peritonei (PMP) arising from the appendix. High peritoneal carcinomatosis index (PCI) is associated with an increased risk of surgical complications. The objective of this study was to present the results of a planned two-step surgical strategy to decrease postoperative morbidity and improve resectability of patients with very high PCI. METHODS: All consecutive patients who underwent a planned two-step surgical approach for PMP between January 2012 and March 2020 were retrospectively included. This approach was offered for patients with low-grade PMP with PCI > 28 for which feasibility of a complete CRS in one operation was uncertain. The first surgery included a complete CRS of the inframesocolic compartment and omentectomy. HIPEC was delivered at the second surgery, after complete CRS of the supramesocolic compartment. Postoperative morbidity was assessed using the Clavien-Dindo classification and survival results were also collected. RESULTS: Eight patients underwent the two-step approach. The median PCI was 33 (29-39) and the median time between the two procedures was 111 days (90-212 days). One patient was deemed unresectable at the second surgery. The rate of major morbidity was 0% for the first step and 25% for the second step, with no mortality. Median follow-up was 53.8 months (3-73 months). CONCLUSION: A two-step surgical management for low-grade PMP patients with very high PCI is safe and feasible, with acceptable postoperative morbidity and no compromise on oncological outcomes.
Entities:
Keywords:
Bulky pseudomyxoma; High peritoneal carcinomatosis index; Peritoneal metastasis resectability; Two stage complete cytoreductive surgery
Authors: Terence C Chua; Brendan J Moran; Paul H Sugarbaker; Edward A Levine; Olivier Glehen; François N Gilly; Dario Baratti; Marcello Deraco; Dominique Elias; Armando Sardi; Winston Liauw; Tristan D Yan; Pedro Barrios; Alberto Gómez Portilla; Ignace H J T de Hingh; Wim P Ceelen; Joerg O Pelz; Pompiliu Piso; Santiago González-Moreno; Kurt Van Der Speeten; David L Morris Journal: J Clin Oncol Date: 2012-05-21 Impact factor: 44.544
Authors: B Menassel; A Duclos; G Passot; A Dohan; C Payet; S Isaac; P J Valette; O Glehen; P Rousset Journal: Eur J Surg Oncol Date: 2016-01-22 Impact factor: 4.424
Authors: K Govaerts; R J Lurvink; I H J T De Hingh; K Van der Speeten; L Villeneuve; S Kusamura; V Kepenekian; M Deraco; O Glehen; B J Moran Journal: Eur J Surg Oncol Date: 2020-02-28 Impact factor: 4.424