Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Pseudomyxoma Peritonei of Appendiceal Origin - 801 Cases from a Single Institution in China

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DOI: https://doi.org/10.30564/jor.v2i2.2272

Abstract:
As more and more centers has published their treatment results of
pseudomyxoma peritonei (PMP) with cytoreductive surgery (CRS) and
hyperthermic intraperitoneal chemotherapy (HIPEC), the data from China
is missing. Myxoma Department of Aerospace Hospital is the biggest
center treating PMP in China. The purpose of this study is to report the
early and long-term outcomes for PMP from this single center. Methods:
801 appendix-derived PMP out of 1008 consecutive patients treated in
Myxoma Department of Aerospace Hospital between 2008 and 2019 were
retrospectively analyzed. Results: Complete cytoreductive surgery (CCRS)
was achieved in 240 (30%) patients with median PCI of 14(1~39), and
the rest had maximal tumor debulking (MTD), HIPEC was implemented
in 96.3% of CCRS and 78.6% of MTD. The major morbidity (grade
III/IV) was 11.4% and the 30-day operative mortality is 0.7%. The 5-
and 10-year OS of CCRS was 76.9% and 64.1%, which is significantly
higher than MTD (5-, 10-year OS as 36.1%, 27.1%; p<0.001). On the
univariate analysis, all prognostic factors (gender, PSS, interval time, prior
chemotherapy, prior HIPEC, Peritoneal Cancer Index (PCI), completeness
of cytoreduction (CC), HIPEC, pathology, present of serous ascites) were
found to be associated with overall survival except for age. On multivariate
analysis, only PCI>20, MTD, high pathologic grade and without HIPEC
were independent factors predicting poorer prognosis. Conclusions: CCRS
+HIPEC can benefit PMP well with controllable risks. MTD+HIPEC may
benefit PMP as well when CCRS cannot be achieved after fully asscessment
by an experienced peritoneal maglignacy center, but the surgery should be
performed as limited as possible.
References:

[1]Sugarbaker PH. Pseudomyxoma peritonei. A cancer whose biology is characterized by a redistribution phenomenon. Ann Surg., 1994, 219(2): 109-111. DOI: 10.1097/00000658-199402000-00001 [2]Baratti D, Kusamura S, Milione M, et al. Pseudomyxoma Peritonei of Extra-Appendiceal Origin: A Comparative Study. Ann Surg Oncol., 2016, 23(13): 4222-4230. DOI: 10.1245/s10434-016-5350-9 [3]Prayson RA, Hart WR, Petras RE. Pseudomyxoma peritonei. A clinicopathologic study of 19 cases with emphasis on site of origin and nature of associated ovarian tumors. Am J Surg Pathol., 1994, 18(6): 591-603. [4]Ronnett BM, Shmookler BM, Diener-West M, Sugarbaker PH, Kurman RJ. Immunohistochemical evidence supporting the appendiceal origin of pseudomyxoma peritonei in women. Int J Gynecol Pathol., 1997, 16(1): 1-9. DOI: 10.1097/00004347-199701000-00001 [5]Szych C, Staebler A, Connolly DC, Wu R, Cho KR, Ronnett BM. Molecular genetic evidence supporting the clonality and appendiceal origin of Pseudomyxoma peritonei in women. Am J Pathol., 1999, 154(6): 1849-1855. DOI: 10.1016/S0002-9440(10)65442-9 [6]Cariker M, Dockerty M. Mucinous cystadenomas and mucinous cystadenocarcinomas of the ovary; a clinical and pathological study of 355 cases. Cancer, 1954, 7(2): 302-310. DOI: 10.1002/1097-0142(195403)7:2<302::aid-cncr2820070214>3.0.co;2-9 [7]Gough DB, Donohue JH, Schutt AJ, et al. Pseudomyxoma peritonei. Long-term patient survival with an aggressive regional approach. Ann Surg., 1994, 219(2): 112-119. DOI:10.1097/00000658-199402000-00002 [8]Miner TJ, Shia J, Jaques DP, Klimstra DS, Brennan MF, Coit DG. Long-term survival following treatment of pseudomyxoma peritonei: an analysis of surgical therapy. Ann Surg., 2005, 241(2): 300-308. DOI: 10.1097/01.sla.0000152015.76731.1f [9]Sugarbaker PH, Chang D. Results of treatment of 385 patients with peritoneal surface spread of appendiceal malignancy. Ann Surg Oncol., 1999, 6(8): 727-731. DOI: 10.1007/s10434-999-0727-7 [10]Chua TC, Moran BJ, Sugarbaker PH, et al. Earlyand long-term outcome data of patients with pseudomyxoma peritonei from appendiceal origin treated by a strategy of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. J Clin Oncol., 2012, 30(20): 2449-2456. DOI: 10.1200/JCO.2011.39.7166 [11] Ansari N, Chandrakumaran K, Dayal S, Mohamed F, Cecil TD, Moran BJ. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in 1000 patients with perforated appendiceal epithelial tumours. Eur J Surg Oncol., 2016, 42(7): 1035-1041. DOI: 10.1016/j.ejso.2016.03.017 [12] Narasimhan V, Wilson K, Britto M, et al. Outcomes Following Cytoreduction and HIPEC for Pseudomyxoma Peritonei: 10-Year Experience [published online ahead of print, 2019 May 14]. J Gastrointest Surg., 2019, 10.1007/s11605-019-04239-4. DOI: 10.1007/s11605-019-04239-4 [13]National Comprehensive Cancer Network. (NCCN) Clinical Practice Guidelines in Oncology. Colorectal Cancer, Version 2, 2020. [14]Järvinen P, Ristimäki A, Kantonen J, et al. Comparison of serial debulking and cytoreductive surgery with hyperthermic intraperitoneal chemotherapy in pseudomyxoma peritonei of appendiceal origin. Int J Colorectal Dis., 2014, 29(8): 999-1007. DOI: 10.1007/s00384-014-1933-8 [15]Andréasson H, Graf W, Nygren P, Glimelius B, Mahteme H. Outcome differences between debulking surgery and cytoreductive surgery in patients with Pseudomyxoma peritonei. Eur J Surg Oncol., 2012, 38(10): 962-968. DOI: 10.1016/j.ejso.2012.07.009 [16]Carr NJ, Cecil TD, Mohamed F, et al. A Consensus for Classification and Pathologic Reporting of Pseudomyxoma Peritonei and Associated Appendiceal Neoplasia: The Results of the Peritoneal Surface Oncology Group International (PSOGI) Modified Delphi Process. Am J Surg Pathol., 2016, 40(1): 14-26. DOI: 10.1097/PAS.0000000000000535 [17]Jacquet P, Sugarbaker PH. Clinical research methodologies in diagnosis and staging of patients with peritoneal carcinomatosis. Cancer Treat Res., 1996, 82: 359-374. DOI: 10.1007/978-1-4613-1247-5_23 [18]Sugarbaker PH. Peritonectomy procedures. Ann Surg., 1995, 221(1): 29-42. DOI: 10.1097/00000658-199501000-00004 [19]Bijelic L, Sugarbaker PH. Cytoreduction of the small bowel surfaces. J Surg Oncol., 2008, 97(2): 176-179. DOI: 10.1002/jso.20912 [20]Sugarbaker PH. Peritoneal Metastases, a Frontier for Progress. Surg Oncol Clin N Am., 2018, 27(3): 413-424. DOI: 10.1016/j.soc.2018.02.001 [21]Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg., 2004, 240(2): 205-213. DOI: 10.1097/01.sla.0000133083.54934.ae [22]Li XB, Ma R, Ji ZH, et al. Perioperative safety after cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy for pseudomyxoma peritonei from appendiceal origin: Experience on 254 patients from a single center. Eur J Surg Oncol., 2020, 46(4 Pt A): 600-606. DOI: 10.1016/j.ejso.2020.01.017 [23]Yan F, Lin Y, Zhou Q, Chang H, Li Y. Pathological prognostic factors of pseudomyxoma peritonei: comprehensive clinicopathological analysis of 155 cases. Hum Pathol., 2020, 97: 9-18. DOI: 10.1016/j.humpath.2019.12.008 [24]Fish R, Renehan AG, Punnett G, et al. Referral and treatment pathways for pseudomyxoma peritonei of appendiceal origin within a national treatment programme. Colorectal Dis., 2018, 20(10): 888-896. DOI: 10.1111/codi.14310 [25]Benhaim L, Honoré C, Goéré D, Delhorme JB, Elias D. Huge pseudomyxoma peritonei: Surgical strategies and procedures to employ to optimize the rate of complete cytoreductive surgery. Eur J Surg Oncol., 2016, 42(4): 552-557. DOI: 10.1016/j.ejso.2016.01.015 [26]Munoz-Zuluaga C, Sardi A, King MC, et al. Outcomes in Peritoneal Dissemination from Signet Ring Cell Carcinoma of the Appendix Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. Ann Surg Oncol., 2019, 26(2): 473-481. DOI: 10.1245/s10434-018-7007-3 [27]Funder JA, Jepsen KV, Stribolt K, Iversen LH. Palliative Surgery for Pseudomyxoma Peritonei. Scand J Surg., 2016, 105(2): 84-89. DOI: 10.1177/1457496915598759 [28]Dayal S, Taflampas P, Riss S, et al. Complete cytoreduction for pseudomyxoma peritonei is optimal but maximal tumor debulking may be beneficial in patients in whom complete tumor removal cannot be achieved. Dis Colon Rectum., 2013, 56(12): 1366-1372. DOI: 10.1097/DCR.0b013e3182a62b0d [29]Delhorme JB, Elias D, Varatharajah S, et al. Can a Benefit be Expected from Surgical Debulking of Unresectable Pseudomyxoma Peritonei?. Ann Surg Oncol., 2016, 23(5): 1618-1624. DOI: 10.1245/s10434-015-5019-9 [30]Sugarbaker PH. Cytoreductive surgery and peri-operative intraperitoneal chemotherapy as a curative approach to pseudomyxoma peritonei syndrome. Eur J Surg Oncol., 2001, 27(3): 239-243. DOI: 10.1053/ejso.2000.1038 [31]Glehen O, Mohamed F, Sugarbaker PH. Incomplete cytoreduction in 174 patients with peritoneal carcinomatosis from appendiceal malignancy. Ann Surg., 2004, 240(2): 278-285. DOI: 10.1097/01.sla.0000133183.15705.71 [32]Ihemelandu C, Mavros MN, Sugarbaker P. Adverse Events Postoperatively Had No Impact on LongTerm Survival of Patients Treated with Cytoreductive Surgery with Heated Intraperitoneal Chemotherapy for Appendiceal Cancer with Peritoneal Metastases. Ann Surg Oncol., 2016, 23(13): 4231-4237. DOI: 10.1245/s10434-016-5355-4 [33]Elias D, Gilly F, Quenet F, et al. Pseudomyxoma peritonei: a French multicentric study of 301 patients treated with cytoreductive surgery and intraperitoneal chemotherapy. Eur J Surg Oncol., 2010, 36(5): 456-462. DOI: 10.1016/j.ejso.2010.01.006 [34] Kusamura S, Moran BJ, Sugarbaker PH, et al. Multicentre study of the learning curve and surgical performance of cytoreductive surgery with intraperitoneal chemotherapy for pseudomyxoma peritonei. Br J Surg., 2014, 101(13): 1758-1765. DOI: 10.1002/bjs.9674

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