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Upfront Compared to Delayed Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy for Pseudomyxoma Peritonei Is Associated With Considerably Lower Perioperative Morbidity and Recurrence Rate

Chua, Terence C. BScMed (Hons), MBBS*; Liauw, Winston MBBS, M Med Sci, FRACP; Zhao, Jing MD*; Morris, David L. MD, PhD*

doi: 10.1097/SLA.0b013e31820b4dba
Original Articles

Background: Cytoreductive surgery (CRS) combined with perioperative intraperitoneal chemotherapy (PIC) is a recognized management strategy for pseudomyxoma peritonei. We seek to evaluate the outcomes of patients treated upfront with CRS PIC compared to patients undergoing delayed CRS PIC as salvage or treatment for recurrences after initial debulking surgery.

Methods: Retrospective analysis of patients with low-grade pseudomyxoma peritonei treated within our institution were stratified according to upfront versus delayed CRS PIC after intial debulking surgery. Survival was analyzed using the Kaplan-Meier method and compared using the log-rank test.

Results: Of 83 patients treated, 35 patients (42%) underwent upfront and 48 patients (58%) underwent delayed CRS PIC. The peritoneal cancer index (P = 0.048), amount of blood transfusion intraoperatively (P = 0.003) and duration of operation (P = 0.007) was lesser in the upfront compared to delayed group. Upfront treatment confers 5-year recurrence-free survival benefit (77% vs 37%; P = 0.011) and 10-year overall survival benefit (67% vs 35%; P = 0.054) over delayed treatment.

Conclusion: Upfront CRS PIC seems to confer beneficial perioperative outcomes and lower recurrence rates over delayed CRS PIC. Early referral to centralized treatment centers would seem to be a reasonable strategy to improve outcomes.

In this study, we investigate the perioperative and survival outcomes of patients undergoing upfront compared to delayed cytoreduction and perioperative intraperitoneal chemotherapy for low-grade pseudomyxoma peritonei. We showed that early treatment is associated with improved recurrence-free survival and lower perioperative morbidity.

*UNSW Department of Surgery.

Department of Medical Oncology, Cancer Care Centre, St George Hospital, Kogarah, Sydney, Australia.

Reprints: David L. Morris, MD, PhD, Department of Surgery, University of New South Wales, St George Hospital, Level 3 Pitney Building, Short St, Kogarah, NSW 2217, Sydney, Australia. E-mail:

© 2011 Lippincott Williams & Wilkins, Inc.