From the Research
The most appropriate treatment for a 33-year-old male patient with pseudomyxoma peritonei (PMP) two months after appendicectomy is option A: HIPEC (hyperthermic intraperitoneal chemotherapy) with peritonectomy and debulking surgery. This comprehensive approach offers the best chance for disease control in PMP, which is characterized by mucinous tumor cells that spread throughout the peritoneal cavity. The treatment involves surgical removal of all visible tumor deposits (cytoreductive surgery/debulking) along with removal of affected peritoneal surfaces (peritonectomy), followed by circulation of heated chemotherapy directly in the abdominal cavity (HIPEC) to eliminate microscopic disease. This combined approach has shown superior outcomes compared to HIPEC alone (option B), systemic chemotherapy alone (option C), or right hemicolectomy (option D), which would be insufficient for addressing the widespread peritoneal disease characteristic of PMP. The procedure should be performed at a specialized center with experience in peritoneal surface malignancies, as it is complex and requires specific expertise to maximize benefit while minimizing complications.
Key points to consider in the management of PMP include:
- The importance of complete cytoreductive surgery (CCRS) in achieving optimal outcomes, as incomplete cytoreduction is associated with poorer survival and higher recurrence rates 1, 2.
- The role of HIPEC in eliminating microscopic disease and reducing the risk of recurrence, with studies demonstrating improved survival rates with the combination of CCRS and HIPEC 3, 4.
- The need for careful patient selection and evaluation of disease extent and histology to determine the best approach for each individual, with factors such as age, histological grade, and disease distribution influencing the decision to proceed with iterative surgery 5.
- The potential for iterative surgery in selected patients with recurrent PMP, with studies showing good oncological outcomes in this setting 2, 5.
Overall, the combination of HIPEC with peritonectomy and debulking surgery offers the most effective approach for managing PMP, with the goal of achieving complete cytoreduction and minimizing the risk of recurrence.