Oncology/endocrineImproved survival of patients with pseudomyxoma peritonei receiving intraperitoneal chemotherapy with cytoreductive surgery: a systematic review and meta-analysis
Section snippets
Background
Pseudomyxoma peritonei (PMP) is a rare intraperitoneal tumor that originates primarily from appendiceal epithelial neoplasms, usually from ruptured low-grade appendiceal mucinous neoplams [1], [2], [3], [4]. The primary tumor enlarges, leading to obstruction of the appendiceal lumen, which results in perforation of the appendix and dissemination of the tumor within the peritoneal cavity [3], [5]. The disseminated neoplastic cells produce mucin, which leads to the characteristic mucinous ascites
Literature search strategy
The literature was searched using the key terms “pseudomyxoma peritonei” and “intraperitoneal chemotherapy” through September 30, 2011, using the databases of PubMed, OVID MEDLINE, and the Cochrane Library. Studies were limited journal articles that were in the English language, published within the last 20 y to exclude articles published before the use of IPEC.
Exclusion criteria
Case reports, review articles, and abstracts were excluded, as were studies were IPEC was not used, studies which had insufficient
Results
Fifteen studies that reported data on 1624 patients were identified (Table 1). Nine different regimens for HIPEC were used. Five different regimens of EPIC were used, although insufficient data was reported for examining survival rates of two of these regimens (regimens 4 and 5).
The mean mortality rate for the 14 of the 15 studies was 3.75 (one study did not report morbidity and mortality), with a median mortality of 2.45. The mean and median morbidity were 35.75 and 40, respectively. Mean
Discussion
There have been very few clinical trials documenting the use of IPEC and cytoreductive surgery for the treatment of PMP and most of the data on this treatment modality comes from case reports and case series. The lack of data does make an extensive meta-analysis difficult, especially since there is no way to control for the differences in patients, treatment regimens, etc. However, the data that was collected from the studies that have been reported can provide some beneficial insights into the
Conclusion
PMP is a rare disease; however, it remains a disease that can cause significant morbidity and will ultimately result in death if not treated. Historically, treatments have primarily attempted to reduce tumor burden but patients often had to undergo multiple surgeries and the vast majority of patients recurred within 2 years of their first surgery. Treating PMP with a combination of cytoreductive surgery and IPEC can greatly improve survival compared to the natural history of the disease and
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Prognostic Impact of Pathology, Cytoreduction, and Tumor Markers in Pseudomyxoma Peritonei
2022, Journal of Surgical ResearchCitation Excerpt :However, with this treatment combination, the 5-y OS rate of patients with PMP may reach up to 70%.18,19,21 Despite morbidity and mortality, the biological characteristics of this neoplasm, namely, its slow growth and rarely distant metastases, make locoregional treatment with a combination of cytoreduction and HIPEC preferable.1,14,21-23 HIPEC was not performed in some cases in the cohort because it was not available in the institution during a period of the study.
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2020, Journal of Surgical ResearchMetronomic Capecitabine With Cyclophosphamide Regimen in Unresectable or Relapsed Pseudomyxoma Peritonei
2019, Clinical Colorectal CancerNonhome discharge and prolonged length of stay after cytoreductive surgery and HIPEC
2019, Journal of Surgical ResearchPressurized intraperitoneal aerosol chemotherapy as an innovative approach to treat peritoneal carcinomatosis
2015, Medical HypothesesCitation Excerpt :In addition, in women with PC from colon cancer and pseudomyxoma peritonei (PMP), a multimodal treatment approach with cytoreductive surgery and IPC is considered the mainstay of treatment [6,7]. In a systematic review and meta-analysis of 15 studies, for example, McBride et al. report mean 3-year, 5-year, and 10-year survival rates of 77%, 76%, and 57%, respectively, in women with PMP treated with cytoreductive surgery and IPC [7]. However, combining cytoreductive surgery with IPC has a high morbidity and a considerable mortality.
Pseudomyxoma peritonei originating from appendix tumors
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