The Pattern, Management, and Outcomes of Recurrence Following Cytoreductive Surgery for Pseudomyxoma Peritonei.

Backgrounds: We aimed to assess the pattern, management, and outcomes of recurrent pseudomyxoma peritonei (PMP) following cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) and compare repeat and index CRS/HIPEC.

Methods: A retrospective review was performed of patients undergoing CRS/HIPEC for PMP between 01/01/2008 and 30/06/2022 at a tertiary referral center in New Zealand. Multivariate logistic regression was used to identify independent predictors of repeat CRS/HIPEC. Overall survival (OS) of PMP recurrence was stratified according to management strategy.

Results: Among 183 primary CRS/HIPEC for appendiceal PMP, 154 (84.2%) achieved complete cytoreduction. Median follow-up duration was 72.1 months. Forty-nine recurred (31.8%). 40 (81.6%) cases of recurrence were isolated to the peritoneal cavity, and 47 (95.9%) occurred within 5 years. 27 (55.1%) underwent repeat curative-intent surgery. 22 (44.9%) were managed with palliative intent. Age > 65 and high-grade carcinoma peritonei (HG) were independent negative predictors of repeat curative-intent surgery. Five-year overall survival was significantly higher in patients undergoing repeat curative-intent surgery (80.3%) compared to those managed with palliative intent (44.8%) (HR = 0.23, p < 0.001). Curative-intent repeat surgery was an independent predictor of overall survival in PMP recurrences. Compared to primary CRS/HIPEC, repeat CRS/HIPEC were less extensive procedures conducted in cases with a lower peritoneal cancer index. Repeat CRS/HIPEC had similar peri-operative morbidity and long-term survival to primary procedures.

Conclusions: Repeat CRS/HIPEC for recurrent PMP is feasible and has similar safety and efficacy to index operations. Favorable long-term outcomes are achievable in well-selected patients.