Abstract

Introduction: Pseudomyxoma peritonei (PMP) is a rare disease characterized by the progressive accumulation of mucinous ascites and peritoneal implants. The optimal treatment for PMP includes the association of complete cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC). For patients with a large burdensome disease, the completeness of cytoreduction sometimes requires maximal effort surgery. The aim of this article is to provide proof of concept for two stage cytoreductive surgery (CRS) in this category of patients.

Methods and materials: A two stage CRS and HIPEC with oxaliplatin was proposed for patients with bulky PMP including important involvement of the serosal surfaces of the bowel or colon who had an impaired nutritional status. The residual disease at the end of the first stage was less than 5 mm of thickness on several implants. Clinical, surgical and histopathological variables were analyzed.

Results: All eight patients completed the two-stage strategy. Mortality was nil. One Clavien Dindo grade 3 event occurred in each stage. After a median follow up of 29.5 months, all patients were alive and free of recurrence. All of the patients had histopathological complete response on the specimens obtained from the residual sites during the second stage surgery.

Conclusions: Two-stage surgical strategy is feasible for bulky PMP patients and it is associated with little high-grade morbidity and enhanced visceral sparing.

摘要

简介：腹膜假单胞菌（PMP）是一种罕见疾病，其特征是粘液性腹水和腹膜植入物逐渐积累。PMP的最佳治疗方法包括完整的细胞减灭术和腹膜高温化疗（HIPEC）。对于患有沉重疾病的患者，细胞减少的完整性有时需要最大的努力。本文的目的是为这类患者提供两阶段减细胞手术（CRS）的概念证明。

方法和材料：提出了一种两阶段CRS和HIPEC联合奥沙利铂用于PMP庞大的患者，其中包括营养状况受损的肠或结肠浆膜表面的严重受累。在第一阶段结束时，一些植入物上的残留疾病厚度小于5毫米。临床，手术和组织病理学变量进行了分析。

结果：所有八名患者均完成了两阶段策略。死亡率为零。每个阶段发生一次Clavien Dindo 3级事件。中位随访29.5个月后，所有患者均存活并且无复发。在第二阶段手术期间，所有患者对从残留部位获得的标本均具有组织病理学完全反应。

结论：两阶段手术策略对于大块的PMP患者是可行的，并且与高发率和内脏保留的增加有关。