Abstract
Introduction. Increasing numbers of patients with pseudomyxoma peritonei (PMP) of appendiceal origin are being evaluated with a low tumor burden. We explored a minimally invasive approach for this group of patients. Materials and Methods. We designed a protocol in which patients with a PMP diagnosis would have a diagnostic laparoscopy. If limited carcinomatosis (PCI ≤ 10) is identified, the procedure will continue laparoscopically. If extensive carcinomatosis (PCI > 10) is found, then the procedure will be converted to an open approach. Results. From December 2008 to December 2011, 19 patients had a complete cytoreduction and HIPEC: 18 of them (95%) were done laparoscopically and 1 of them (5%) was converted to an open procedure. Mean PCI was 4.2. Grade 3 morbidity was 0, and one patient (5%) experienced a grade 4 complication, needing a reoperation for an internal hernia. There were no mortalities. Mean length of hospital stay was 5.3 days. At a mean follow-up of 17 months (1–37) all 19 patients are alive and free of disease. Conclusion. This study demonstrates that cytoreductive surgery and HIPEC via the laparoscopic route is feasible and safe and should be offered to patients with limited pseudomyxoma peritonei of appendiceal origin.
Highlights
Increasing numbers of patients with pseudomyxoma peritonei (PMP) of appendiceal origin are being evaluated with a low tumor burden
The purpose of this paper is to report our continued experience from this protocol in patients with pseudomyxoma peritonei of appendiceal origin, referred to as low-grade mucinous carcinoma peritonei (L-MCP) or disseminated peritoneal adenomucinosis (DPAM)
From December 2008 to December 2011, 30 patients with limited peritoneal surface malignancies were taken to the operating room for a laparoscopic cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC)
Summary
Increasing numbers of patients with pseudomyxoma peritonei (PMP) of appendiceal origin are being evaluated with a low tumor burden. This study demonstrates that cytoreductive surgery and HIPEC via the laparoscopic route is feasible and safe and should be offered to patients with limited pseudomyxoma peritonei of appendiceal origin. An obvious disadvantage of treating every patient with PMP with a very large incision in order to rule out the presence of any residual disease is the fact that many of these patients are going to have very limited peritoneal disease. This approach represents an opportunity to improve patient care. Prospective randomized trials have shown that there is no difference in port site and wound recurrence, no difference in distant recurrence, and no difference in survival in patients undergoing laparoscopic surgery for primary colon cancer, some of these studies show a better outcome in those having laparoscopic surgery [5]
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