Surgical management of pseudomyxoma peritonei: low-volume center experience.

Introduction: Pseudomyxoma peritonei (PMP) is a rare disease characterized by diffuse peritoneal invasion of multifocal mucinous deposits. Gold standard treatment involves cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC). We aimed to compare the outcomes of operated PMP patients in a low-volume center, with those of high-volume centers and using other regimens.

Materials and methods: Retrospective analysis was conducted for PMP patients treated by CRS + HIPEC (using the Elias high-dose Oxaliplatin HIPEC regimen) over a 15-year period (January 2007 - December 2021) at the Jules Bordet Institute - H.U.B.

Results: 32 patients were included. Pathology results were: 21.9% acellular mucin, 34.4% low-grade, and 43.7% high-grade. The median peritoneal cancer index was 24 (range 3-36). The median follow-up was 58 months. The rate of major complications (Clavien-Dindo III/IV) was 41% and postoperative mortality was 3%. Mean disease-free survival (DFS) was estimated at 40 +/- 4 months (standard deviation (SD)) while overall survival (OS) was 122 +/- 9 months (SD). DFS reached a plateau of 44.5% at 5 and 10 years and OS was 92.3% and 76.2% respectively. Statistical analysis showed low-grade PMP to be predictive of better DFS and OS (p = 0.0111 and p = 0.0293 respectively). We also found that female gender was predictive of better DFS (p = 0.0262).

Conclusion: Our postoperative morbidity and mortality rates, DFS, and OS were similar to those reported in the literature for high-volume PMP centers. Our theory is that surgical proficiency can be more attributed to the surgeon's CRS experience, regardless of the nature of the disease.