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Treatment of advanced pseudomyxoma peritonei using cytoreductive surgery including total gastrectomy and perioperative chemotherapy
Author(s) -
Sugarbaker Paul H.,
Chang David
Publication year - 2021
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.26506
Subject(s) - medicine , pseudomyxoma peritonei , perioperative , gastrectomy , surgery , appendix , chemotherapy , univariate analysis , intraperitoneal chemotherapy , cancer , multivariate analysis , paleontology , biology , ovarian cancer
Background Pseudomyxoma peritonei is a disease caused by the widespread distribution of mucinous tumor into the peritoneal space from a perforated appendiceal neoplasm. Methods All patients in this study had cytoreductive surgery with total gastrectomy plus perioperative intraperitoneal chemotherapy. A high diverting jejunostomy was used on all patients. Patient characteristics, adverse events, and survival were accumulated prospectively. Results Fifty‐eight patients were available for long‐term follow‐up. In the univariate analysis, features associated with a less favorable outcome included female gender ( p = 0.0127), intestinal obstruction before treatment ( p = 0.00791), and prior surgical score (PSS) ( p = 0.0054). In the multivariate analysis, the two significant variables were grade ( p = 0.0458) and PSS ( p = 0.0041). Median survival was 12 years with a 5‐, 10‐, and 20‐year survival of 76%, 58%, and 37%, respectively. There were two postoperative deaths (3.4%) and Grades 3 and 4 adverse events in 20 (34.5%) patients. Conclusions A 10‐year survival after cytoreductive surgery, total gastrectomy with temporary high diverting jejunostomy, and perioperative chemotherapy occurred in 58% of these patients with advanced pseudomyxoma peritonei. High‐grade disease and extensive prior surgery with a high PSS were associated with reduced benefit.