Cytoreductive surgery and intraperitoneal chemotherapy for pseudomyxoma peritonei

Background and aims: Surgical improvement can be achieved in selected patients with pseudomyxoma peritonei (PMP) by major cytoreductive surgery and intraperitoneal chemotherapy (IPEC). The purpose of this retrospective study was to analyze morbidity, mortality, and survival following therapy. Patients and methods: Between July 1995 and September 2003, 28 patients (mean age 56 years, range 28-79) with PMP were operated on with the aim of complete macroscopical cytoreduction. Surgery was followed by IPEC. Results: A macroscopically complete cytoreduction was achieved in 11 patients (40%). The mean operating time was 6 h with a mean of three peritonectomy procedures per patient. Cisplatin (15 out of 28), mitomycin C (6 out of 28) and 5-FU (7 out of 28) were used for the intraoperative chemotherapy. Overall morbidity was 36%. Most frequent surgical complications were digestive fistulae (3 out of 28), abscesses (5 out of 28) and bleeding (2 out of 28). Two patients died postoperatively. Patients with low tumor volume (mean survival time 78+/-11 vs. 37+/-9 months, p=0.05) and complete cytoreduction (73+/-10 vs. 24+/-8 months, p<0.05) had an improved prognosis. Conclusions: 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.