Cytoreductive surgery and intraperitoneal chemotherapy for pseudomyxoma peritonei

Güner, Zeynep Esra; Schmidt, Ulf; Dahlke, Marc H.; Schlitt, Hans J.; Klempnauer, Jürgen; Piso, Pompiliu

doi:10.1007/s00384-004-0648-7

Cited by 62 publications

(29 citation statements)

References 27 publications

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“…A number of series using this approach has now been published, showing indeed that longterm disease free and progression free survival can be improved. [3][4][5][6]15,16 Still, even after this combined modality treatment progression was observed in our series in 41% of cases. In other published series recurrence or progression rates of 40-70% have been reported.…”

Section: Discussionsupporting

confidence: 41%

“…1 Aggressive cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is a treatment strategy for PMP with promising survival results. [2][3][4][5] The peritonectomy procedures are a useful tool to optimize resection of macroscopic peritoneal implants. HIPEC seems to reduce the recurrence or progression rate significantly by the cytotoxic effect on (microscopic) tumor residue, especially in patients with low-grade pathology and complete cytoreduction.…”

mentioning

confidence: 99%

“…HIPEC seems to reduce the recurrence or progression rate significantly by the cytotoxic effect on (microscopic) tumor residue, especially in patients with low-grade pathology and complete cytoreduction. 3,[5][6][7] Recurrent or progressive disease after this combined modality treatment is however, still a problem. Treatment approaches for recurrent or progressive PMP are not well described, although surgery seems to be the most common option.…”

mentioning

confidence: 99%

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Progression of Pseudomyxoma Peritonei after Combined Modality Treatment: Management and Outcome

et al. 2006

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Background: Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is a treatment strategy for pseudomyxoma peritonei (PMP) with curative intent. The aim of this study was to determine the patterns of failure in patients who underwent such a procedure and to evaluate management and outcome of progressive disease.Methods: After exclusion of patients with overt malignancy, progression was studied in 96 PMP patients treated primarily by CRS with HIPEC. Location, pathology, management and outcome were recorded.Results: Median follow-up was 51.5 months (0.1-99.5). Median progression free survival (PFS) was 28.2 months (95% CI 18.3->). Progressive disease was mainly located sub hepatic (38%) or in multiple regions (36%). Pathological dedifferentiation was observed in 8 patients (20%). The choice of treatment depended on pathology, extent of disease and PFS. Seventeen patients were treated for progression by second CRS with (n=8) or without HIPEC (n=10). The 3-years overall survival (OS) probability after this treatment was 100% and 53.3% (95% CI 28.2-100%), respectively. Fifteen patients with (slow) progression were observed. Threeyears OS probability of these patients was 66.0% (95% CI 43.4-100%). All patients treated for progression by systemic chemotherapy only (n=6) had died of disease after a median follow up of 14.8 (9.8-33.6) months. A longer PFS after primary treatment was associated with longer OS after progression (P = 0.04).Conclusions: Progressive PMP after primary CRS with HIPEC is probably the result of technical failure and/or tumor biology. Management of progressive PMP can be valuable for selected patients and should depend primarily on the PFS.

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Section: Discussionsupporting

confidence: 41%

mentioning

confidence: 99%

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confidence: 99%

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Progression of Pseudomyxoma Peritonei after Combined Modality Treatment: Management and Outcome

et al. 2006

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“…Results are encouraging with a 5-ys-OS ranging from 62.5 to 100% for low grade PMP and from 0 to 65% for high grade disease . This differentiation is crucial for the evolution of disease; low grade tumours are slow growing and indolent differently from those high grade, fast growing and aggressive (Sugarbaker and Chang, 1999;Witkamp et al, 2001;Güner et al, 2005;Moran et al, 2008;Moran and Cecil, 2003;Murphy et al, 2007;Baratti et al, 2008;Elias et al, 2008;Loungnarath et al, 2005;Smeenk et al, 2007;Stewart et al, 2005;Yan et al, 2006). The goal of the surgical cytoreduction is to remove all the visible tumor by the following procedures: right subdiaphragmatic and parietal peritonectomy, left subdiaphragmatic and parietal peritonectomy,greater omentectomy with splenectomy, lesser omentectomy and stripping of the omental bursa, andpelvic peritonectomy with salpingo-oophorectomy in women.…”

Section: Advanced Oncological Surgery In Pseudomyxoma Peritoneimentioning

confidence: 99%

Abdominal Advanced Oncologic Surgery

Pasqual¹,

Bertozzi²

2012

Abdominal Surgery

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“…Przyjęta graniczna wartość średnicy zmian odpowiada głębokości penetracji mitomycyny C. Część autorów w kolejnym etapie zaleca chemioterapię dootrzewnową (5-fluorouracyl) przez 5 dni. Czas trwania zabiegu chirurgicznego prowadzącego do całkowitej cytoredukcji wynosi średnio około 10 godzin [32]. Klasyfikacja doszczętności zabiegu opracowana przez Sugarbakera wyróżnia 4 stopnie cytoredukcji (tab.…”

Section: Omówienieunclassified

Pseudomyxoma peritonei – diagnostic and therapeutic difficulties. Literature review and

Daniluk¹,

Jurkowska²,

Bandurski³

et al. 2012

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Słowa kluczowe: śluzak rzekomy otrzewnej, guzy wyrostka robaczkowego, cytoredukcyjne leczenie operacyjne, hipertermiczna dootrzewnowa chemioterapia. Key words: pseudomyxoma peritonei, appendiceal tumours, cytoreductive therapy, hyperthermic intraperitoneal chemotherapy. StreszczenieŚluzak rzekomy otrzewnej (pseudomyxoma peritonei -PMP) jest rzadką, postępującą chorobą charakteryzującą się nadmierną akumulacją śluzu w jamie otrzewnej. Wywodzi się przypuszczalnie z guzów wyrostka robaczkowego lub guzów jajnika o niskim potencjale złośliwienia. Odmienne biologiczne zachowanie się guzów zlokalizowanych w różnych miejscach utrudnia rozpoznanie i leczenie. Tomografia komputerowa jest preferowaną metodą obrazowania, umożliwiającą kwalifikację chorych do zabiegu chirurgicznego oraz ocenę pooperacyjną. Terapia PMP jest leczeniem paliatywnym, polegającym głównie na wielokrotnych zabiegach chirurgicznych cytoredukacyjnych, niekiedy w połączeniu z dootrzewnową chemioterapią hipertermiczną. Stosowane metody zmniejszyły śmiertelność i chorobowość. Pomimo małej agresywności choroby nie jest możliwe jej wyleczenie, a oczekiwany czas przeżycia chorych jest ograniczony. W artykule opisano przypadek chorego ze śluzakiem rzekomym otrzewnej oraz przedstawiono dostępne dane z piśmiennictwa na temat choroby. AbstractPseudomyxoma peritonei (PMP) is a rare, progressive disease with extensive mucinous accumulation within the peritoneal cavity. It originates from low malignant potential tumours of the appendix or ovaries. Different biological behaviour of tumours of various sites leads to a dilemma in diagnosis and management. The computed tomography (CT) scan is the preferred imaging modality in selection of patients for operation and for follow-up. The therapy of pseudomyxoma peritonei is palliative treatment, which consists in multiple cytoreductive surgery and sometimes in hyperthermic intraperitoneal chemotherapy. These methods have reduced mortality and morbidity. Although the disease is minimally invasive, the expected long-term survival is limited with no prospect of cure. This paper describes a case of pseudomyxoma peritonei and presents the available literature data. WstępŚluzak rzekomy otrzewnej (pseudomyxoma peritonei -PMP) jest rzadką chorobą o nieznanym podłożu patogenetycznym. Charakteryzuje się gromadzeniem w obrębie jamy brzusznej dużej ilości galaretowatego śluzu oraz obecnością na powierzchni otrzewnej sieci komórek nabłonkowych produkujących śluz. Śluz składa się z kwaśnych mukopolisacharydów, może też zawierać komórki o charakterze łagodnym lub złośliwym. W piś -miennictwie anglojęzycznym opisującym PMP często używa się określania jelly belly, co oznacza galaretowaty brzuch. Chorobę po raz pierwszy przedstawił Rokitansky w 1842 roku [1]. Termin PMP wprowadził Werth w 1884 roku [2]. Na początku XX wieku Frankel wykazał związek pomiędzy tą chorobą a pierwotnym guzem w obrębie wyrostka robaczkowego [3]. Śluzak rzekomy

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Cytoreductive surgery and intraperitoneal chemotherapy for pseudomyxoma peritonei

Abstract: Cytoreductive surgery combined with IPEC is associated with acceptable morbidity and mortality. Complete cytoreduction may improve survival, particularly in selected patients with PMP who have a low tumor volume, complete cytoreduction, and no organ metastases.

Cited by 62 publications

References 27 publications

Progression of Pseudomyxoma Peritonei after Combined Modality Treatment: Management and Outcome

Progression of Pseudomyxoma Peritonei after Combined Modality Treatment: Management and Outcome

Abdominal Advanced Oncologic Surgery

Pseudomyxoma peritonei – diagnostic and therapeutic difficulties. Literature review and

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