Cytoreductive surgery and hyperthermic intra-peritoneal chemotherapy (HIPEC) in the treatment of pseudomyxoma peritonei: ten years experience in a single center.

BACKGROUND Pseudomyxoma peritonei (PMP) is a rare and fatal disease for which no standard treatment has been established. Encouraging results have been recently reported with the combination of cytoreductive surgery (CRS) and hyperthermic intra-peritoneal chemotherapy (HIPEC). PATIENTS AND METHODS Seventy-five patients with PMP underwent CRS and closed abdomen HIPEC with mytomicin-C and cis-platinum over 10 years at a single institution. Potential clinicopathological prognostic variables were tested using multivariate analysis. RESULTS Optimal cytoreduction (residual tumor nodules < or = 2.5 mm) was performed in 72 patients (96%). Operative mortality was 1%. Five-year overall (OS) and progression-free (PFS) survival were 78.3% and 31.1% in the overall series, respectively. Optimal CRS, no previous systemic chemotherapy and low histological aggressiveness were independent predictors of better OS and PFS using multivariate analysis. CONCLUSION Favourable outcome after CRS and HIPEC can be expected in patients affected by PMP variants with low histological aggressiveness, undergoing optimal surgical cytoreduction and with no pre-operative systemic chemotherapy.