Complete pathologic response after two-stage cytoreductive surgery with HIPEC for bulky pseudomyxoma peritonei: proof of concept.

Fiche publication


Date publication

janvier 2020

Journal

International journal of hyperthermia : the official journal of European Society for Hyperthermic Oncology, North American Hyperthermia Group

Auteurs

Membres identifiés du Cancéropôle Est :
Pr BIBEAU Frédéric


Tous les auteurs :
Sgarbura O, Al Hosni M, Petruzziello A, Figueroa R, Khellaf L, Pissas MH, Carrère S, Nougaret S, Bibeau F, Quénet F

Résumé

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

Mots clés

Pseudomyxoma peritonei, cytoreductive surgery, hyperthermic intraperitoneal chemotherapy, oxaliplatin, two-stage surgery

Référence

Int J Hyperthermia. 2020 ;37(1):585-591