Challenges in choice of the treatment strategy for patients with recurrent pseudomyxoma peritonei

Abstract

Pseudomixoma peritonei is a rare type of peritoneal carcinomatosis demonstrating an indolent course and a high rate of recurrence. primary surgical interventions in patients with pseudomixoma peritonei are extensive and traumatic, which worsens the chances for performing re-operation and may increase the rate of postoperative complications. above mentioned circumstances forms a problem in the choice of management for patients with recurrent pseudomyxoma peritonei. in this article we present a clinical case of successful treatment of recurrent disease.Сlinical case. The 62 years female patient in 2006 first noticed pain in the lower abdomen. the examination revealed a tumor near the right appendages. on 28.12.2006 the uterus was extirpated with appendages, appendectomy, resection of the large omentum; 6 courses of chemotherapy (cap) were conducted. in may 2007 and June 2009, repeated cytoreductive operations were performed with subsequent 12 courses of chemotherapy. in 2012 a patient with a relapse of the disease was re-operated at the N.N. Blokhin NmRcof oncology. Re-operation was performed in the volume of removal of bulk of the tumor in the right and left sub-diaphragmatic spaces with resection of both domes of the diaphragm, splenectomy, removal of the remaining part of the large omentum, with subsequent hyperthermic intraperitoneal chemoperfusion with cisplatin. complications were not noted. after 14 months, ctand ultrasound revealed progression of the disease. in 2013 an attempt was made to re-surgical intervention. during re-operation in the abdominal cavity a massive adhesive process was found. given the palliative nature of the intervention and the high risk of progression, the volume of surgery is limited to a biopsy of the tumor mass. later 4 courses of chemotherapy were conducted. during period of follow-up, relapse of tumor was noted with the development of partial small intestinal obstruction, which did not require emergency intervention. at present, 26 months after the combined treatment, the patient’s condition is satisfactory, with no signs of intestinal obstruction.Сonclusion. Performance repeated surgical interventions for pseudomixoma peritonei is a rather difficult task for, due to the fact that with continued growth, it is more difficult to achieve optimal cytoreduction. the basic condition for re-operation should be referred to the initial optimal level of cytoreduction and a long-term disease-free period.