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Peritonectomy and Intraperitoneal Hyperthermic Perfusion (IPHP): A Strategy That Has Confirmed its Efficacy in Patients with Pseudomyxoma Peritonei

From the Department of Surgery, Melanoma and Sarcoma Unit (DM, DB, SK); Department of Anesthesiology (MGI); Department of Critical Care (BA); Department of Pathology (SA); and Nutritional Care Unit (CG), National Cancer Institute of Milan, Italy.

Correspondence: Address correspondence and reprint requests to: Marcello Deraco, MD, Unità Operativa Melanoma e Sarcoma, Istituto Nazionale per lo Studio e la Cura dei Tumori, via Venezian, 1-20133 Milan, Italy; e-mail marcello.deraco{at}istitutotumori.mi.it

Background: Pseudomyxoma peritonei (PMP) is a rare disease with a poor prognosis characterized by a complete redistribution of mucin within the peritoneal cavity. The aim of this multicentric study was to evaluate the survival, morbidity, toxicity, and mortality of patients with PMP treated by cytoreductive surgery (CRS) with intraperitoneal hyperthermic perfusion (IPHP).

Methods: Thirty-three patients with PMP (21 males and 12 females) were enrolled in a phase II clinical trial. One patient underwent surgery twice because of disease recurrence. CRS was performed with peritonectomy procedures. The closed abdomen technique was employed for IPHP with use of cisplatin (25 mg/m²/L) plus mitomycin-C (3.3 mg/m²/L) for 60 minutes under hyperthermic conditions (42.5°C).

Results: Thirty-one patients (92%) were optimally cytoreduced. Five-year overall survival, progression-free survival, and locoregional progression-free survival rates were 97%, 43%, and 59%, respectively. Grade II and grade III morbidity was observed in 5 patient (15%) and 6 patients (18%), respectively. There was one treatment-related death (3%), 21 days after treatment.

Conclusions: CRS associated with IPHP permitted complete tumor removal with an acceptable morbidity and mortality for patients with PMP. This study confirms the efficacy of the combined treatment in terms of long-term survival and local disease control.

Key Words: Intraperitoneal hyperthermic perfusion • Peritonectomy • Pseudomyxoma peritonei

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