Outcome of a Series of Patients with Pseudomyxoma Peritonei Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy at a Tertiary Cancer Centre in India

Abstract

INTRODUCTION: Cytoreductive surgery (CRS) and

hyperthermic intraperitoneal chemotherapy (HIPEC) is now

the standard of care for the treatment of pseudomyxoma

peritonei (PMP). MATERIALS AND METHODS: This is a

retrospective study of a consecutive series of patients with

PMP treated in our institute from July 2012 to July 2016,

with CRS and HIPEC. CRS consisted of standard

peritonectomy procedures while Mitomycin-C was used for

HIPEC at a dose of 30-35 mg/m2, circulated in the

peritoneal cavity admixed in peritoneal dialysate fluid for

a duration of 60 or 90 minutes, while maintaining a

temperature of 41 to 42 degrees Celsius throughout, using

the closed technique. RESULTS: A total of 13 patients

with PMP were treated during this time period. The median

age of the patients was 55 years (range was 36 to 68

years). The median peritoneal cancer index (PCI) score

was 30 (range 0-39). Completeness of cytoreduction (CC)

score CC0 was achieved in 8 cases and CC1 in 5

cases. The median duration of surgery was 13 hours

(range 6-17 hours). The median blood loss was 1500 ml

(range 200 to 9400 ml). The median duration of stay in the

ICU was 6 days (range 0 to 20 days) whereas the median

duration of hospital stay was 16 days (range 10 to 54

days). Overall morbidity rate was 61.54% with grade III

and IV Clavien-Dindo morbidity seen in 23.08%

cases. There was only one 30-day postoperative mortality

(7.69%). 84.62% patients are alive without recurrence after

a median follow up of 25 months (range 1-57 months).

CONCLUSION: CRS and HIPEC for PMP is a complicated

procedure that should be done in specialized centres, in

which case it is associated with acceptable morbidity and

mortality and good oncological outcomes.