Pseudomyxoma peritonei
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Clinical study
Two-stage surgery with HIPEC in pseudomyxoma peritonei
Complete pathologic response in all patients. Proof of concept published in the International Journal of Hyperthermia.
Pseudomyxoma peritonei (PMP) is a rare disease characterized by progressive accumulation of mucinous ascites and peritoneal implants. When the disease is very bulky, achieving complete cytoreduction in a single procedure can be impossible. This study by Prof. Dr. François Quenet presents a pioneering two-stage strategy with HIPEC that achieves complete pathologic response while preserving organs and minimizing morbidity.
Key results
Study highlights
8
Patients completed the strategy
0%
Mortality
100%
Complete pathologic response
29.5
Months follow-up (median)
What did the study analyse?
A two-stage strategy with cytoreductive surgery and HIPEC with oxaliplatin was proposed for patients with bulky PMP, with significant involvement of the serosal surfaces of the small bowel or colon and impaired nutritional status.
Between June 2014 and June 2018, 8 patients with bulky PMP (PCI >20) were selected for this two-stage strategy at the Institut du Cancer de Montpellier.
Inclusion criteria:
- ✓ PCI >20 with acellular mucin or low-grade mucinous neoplasm
- ✓ Easily detachable gelatinous implants with a base <5 mm
- ✓ Multiple implants on the small bowel requiring ≥3 resections
Surgical strategy
First stage: extensive peritoneal resection and lesions at risk of obstruction, avoiding bowel resections. Residual disease was left <5 mm thick. HIPEC with oxaliplatin 250 mg/m².
Second stage (median 4 months later): complete exploration, resection of all macroscopic lesions, and biopsy or resection of previous residual areas. Second HIPEC.
"The complete pathologic response observed even raises the question of whether the second stage will be necessary in the future."
Conclusion
Two-stage cytoreductive surgery with HIPEC is feasible and safe in patients with bulky pseudomyxoma peritonei. It is associated with low severe morbidity and greater visceral preservation, achieving complete pathologic response in all cases with no mortality.
This strategy is especially promising for low-grade PMP, frail or malnourished patients, and very bulky disease where complete cytoreduction in a single stage would be unfeasible.
Principal investigator
The role of Dr. François Quenet
Prof. Dr. François Quenet is an international reference in peritoneal oncological surgery and a pioneer in the development of surgical strategies for complex peritoneal tumours. This study published in the International Journal of Hyperthermia is one of the first to demonstrate the feasibility of two-stage surgery with HIPEC for bulky pseudomyxoma peritonei.
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