Recurrence of pseudomyxoma peritonei after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

Abstract

Background Pseudomyxoma peritonei (PMP) is a rare clinical condition characterized by mucinous ascites, typically related to appendiceal or ovarian tumours. Current standard treatment involves cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), but recurrences occur in 20–30 per cent of patients. The aim of this study was to define the timing and patterns of recurrence to provide a basis for modifying follow‐up of these patients. Methods This observational study examined a prospectively developed multicentre national database (RENAPE working group) to identify patients with recurrence after optimal CRS and HIPEC for PMP. Postoperative complications, long‐term outcomes and potential prognostic factors were evaluated. Results Of 1411 patients with proven PMP, 948 were identified who had undergone curative CRS and HIPEC. Among these patients, 229 first recurrences (24·2 per cent) were identified: 196 (20·7 per cent) occurred within the first 5 years (early recurrence) and 30 (3·2 per cent) occurred between 5 and 10 years. Three patients developed a first recurrence more than 10 years after the original treatment. The mean(s.d.) time to first recurrence was 2·36(2·21) years. Preoperative chemotherapy and high‐grade pathology were significant factors for early recurrence. Overall survival for the entire group was 77·9 and 63·1 per cent at 5 and 10 years respectively. The principal site of recurrence was the peritoneum. Conclusion Recurrence of PMP was rare after 5 years and exceptional after 10 years.

Retrospective Study of the Epidemiology, Pathology, and Therapeutic Management in Patients With Mucinous Ovarian Tumors

“… 33 - 36 Concurrent cytoreductive surgery and HIPEC administration have also been shown to improve the survival rates in patients with pseudomyxoma peritonei (PMP), although the pathological subtype of PMP remains a crucial factor that influences outcomes. 31 , 37 , 38 Very recently, a multicenter, open-label, randomly controlled, phase 3 trial study demonstrates that the addition of HIPEC to interval cytoreductive surgery resulted in longer recurrence-free survival and overall survival than surgery alone in the patients with epithelial ovarian cancer at stage III (median overall survival, 45.7 months vs 33.9 months). The percentage of patients who experienced adverse side effects of grade 3 or 4 was similar in these 2 groups.…”

Two-step cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for pseudomyxoma peritonei with high peritoneal carcinomatosis index

“…The aggressiveness of the disease was therefore higher than initially expected and might have been the cause of the unfavorable outcome. This highlights the fact that this two-step approach should be reserved for low-grade disease, as high-grade disease presents a higher risk of early recurrence [ 28 ]. In total, at follow-up, 5 patients (62.5%) were alive without disease recurrence, which can be considered comparable to the 5-year disease-free survival reported by Benhaim et al [ 17 ] for extensive PMP patients operated on with a one-step approach (45%).…”

Two-step cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for pseudomyxoma peritonei with high peritoneal carcinomatosis index

“…The aggressiveness of the disease was therefore higher than initially expected and might have been the cause of the unfavourable outcome. This highlights the fact that this two-step approach should probably be reserved for low-grade disease, as high-grade disease presents a higher risk of early reccurence [28].…”