Complete pathological response of high grade appendicular neoplasm induced Pseudomyxoma Peritonei (PMP) after neoadjuvant intra-peritoneal chemotherapy: A case report

Naveen Padmanabhan,Haruaki Ishibashi,Kazurou Nishihara,Shouzou Sako,Kanji Katayama,Satoshi Wakama,Yasuyuki Kamada,Yutaka Yonemura

doi:10.1016/j.ijscr.2020.05.072

Naveen Padmanabhan, Haruaki Ishibashi + Show 6 more

Open Access

https://doi.org/10.1016/j.ijscr.2020.05.072

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Abstract

BackgroundPseudomyxoma Peritonei (PMP) is clinical syndrome characterized by mucinous ascites and gelatinous tumor deposits in the peritoneal cavity. Complete Cytoreduction and Hyperthermic intraperitoneal perfusion is the contemporary standard of care for PMP. A novel treatment approach with Intraperitoneal (IP) chemotherapy has been developed for patients with disease not amenable for complete cytoreduction. Case presentationA 72 year old lady had PMP arising from high grade appendicular neoplasm with extensive intraabdominal spread not suitable for complete cytoreduction (PCI -19; multiple mesenteric deposits). Novel approach with tumor debulking and Neoadjuvant Intraperitoneal chemotherapy was done. Excellent clinical response was obtained after 12 sessions of IP chemotherapy with cisplatin and docetaxel.Subsequently she underwent Complete cytoreductive surgery with peritonectomy and Hyperthermic intraperitoneal chemotherapy. Pathological examination of surgical specimens revealed only acellular mucin with no viable tumor cells indicating a complete response. DiscussionComplete pathological response after IP chemotherapy in extensive PMP is rare. Nevertheless the results are encouraging as the systemic therapy hasn't yielded successful outcomes. IP chemotherapy has the advantage of achieving high intraperitoneal concentrations and down staging the tumor spread. ConclusionNeoadjuvant Intra-peritoneal chemotherapy is a promising neoadjuvant strategy in patients who are poor candidates for upfront resection due to extent of disease or performance status, perhaps better than systemic therapy.

Highlights

Epithelial neoplasms of the appendix is the most common cause of Pseudomyxoma Peritonei (PMP) but it can arise due to mucinous neoplasms of ovary, urachus, pancreas, colon, rectum or rarely stomach [1,2]
The Complete Cytoreductive surgery (CCRS) with peritonectomy procedures and visceral resections as per tumor involvement was described by Paul Sugarbaker [9]
Efforts to reduce tumor burden with systemic therapy have been tried in the past without much value

Summary

BACKGROUND

Pseudomyxoma Peritonei (PMP) is clinical syndrome characterized by mucinous ascites and gelatinous tumor deposits in the peritoneal cavity. A novel treatment approach with Intraperitoneal (IP) chemotherapy has been developed for patients with disease not amenable for complete cytoreduction. CASE PRESENTATION: A 72 year old lady had PMP arising from high grade appendicular neoplasm with extensive intraabdominal spread not suitable for complete cytoreduction (PCI -19; multiple mesenteric deposits). Excellent clinical response was obtained after 12 sessions of IP chemotherapy with cisplatin and docetaxel. She underwent Complete cytoreductive surgery with peritonectomy and Hyperthermic intraperitoneal chemotherapy. CONCLUSION: Neoadjuvant Intra-peritoneal chemotherapy is a promising neoadjuvant strategy in patients who are poor candidates for upfront resection due to extent of disease or performance status, perhaps better than systemic therapy

Introduction

Case presentation

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