Li WW, Ru XM, Xuan HY, Fan Q, Zhang JJ, Lu J. Analysis of therapeutic effect of cell reduction combined with intraperitoneal thermoperfusion chemotherapy in treatment of peritoneal pseudomyxoma. World J Gastrointest Surg 2024; 16(11): 3520-3530 [DOI: 10.4240/wjgs.v16.i11.3520]
Corresponding Author of This Article
Jun Lu, Doctor, Department of Endocrinology, The Second Affiliated Hospital of Soochow University, No. 1055 Sanxiang Road, Suzhou 215004, Jiangsu Province, China. lujun.198404@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Nov 27, 2024; 16(11): 3520-3530 Published online Nov 27, 2024. doi: 10.4240/wjgs.v16.i11.3520
Analysis of therapeutic effect of cell reduction combined with intraperitoneal thermoperfusion chemotherapy in treatment of peritoneal pseudomyxoma
Wei-Wei Li, Xiu-Mei Ru, Hong-Yan Xuan, Qi Fan, Jing-Jing Zhang, Jun Lu
Wei-Wei Li, Xiu-Mei Ru, Hong-Yan Xuan, Jun Lu, Department of Endocrinology, The Second Affiliated Hospital of Soochow University, Suzhou 215004, Jiangsu Province, China
Qi Fan, Jing-Jing Zhang, Department of Anus and Intestine Surgery, Xiangya Hospital of Central South University, Changsha 410008, Hunan Province, China
Author contributions: Li WW wrote the manuscript; Ru XM, Xuan HY, Fan Q and Zhang JJ collected the data; Lu J guided the study. All authors reviewed, edited, and approved the final manuscript and revised it critically for important intellectual content, gave final approval of the version to be published, and agreed to be accountable for all aspects of the work.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Second Affiliated Hospital of Soochow University.
Informed consent statement: This study has obtained informed consent and signed treatment consent from patients and their families.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Statistical analysis plan, informed consent form, and clinical study report will also be shared if requested. Emails could be sent to the address mrfanqi2020@163.com to obtain the shared data.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jun Lu, Doctor, Department of Endocrinology, The Second Affiliated Hospital of Soochow University, No. 1055 Sanxiang Road, Suzhou 215004, Jiangsu Province, China. lujun.198404@163.com
Received: February 21, 2024 Revised: September 6, 2024 Accepted: September 12, 2024 Published online: November 27, 2024 Processing time: 252 Days and 8.8 Hours
Abstract
BACKGROUND
Pseudomyxoma peritonei is a rare tumor that can produce a biological behavior similar to that of a malignant tumor. Surgical resection combined with chemotherapy is the traditional treatment method, but the effect is not good. Cell reduction (CRS) combined with intraperitoneal thermoperfusion chemotherapy (HIPEC) has become a new method for the treatment of peritoneal pseudomyxoma (PMP).
AIM
To find out if CRS and HIPEC can be used safely and effectively to treat PMP.
METHODS
This is an observational study. Clinical data of PMP patients treated with CRS + HIPEC at our hospital from January 2013 to June 2023 was collated and analyzed. The main outcome measures were overall survival (OS), and the secondary outcome measures were the incidence of surgical complications and serious adverse events. Complications were graded according to common adverse event evaluation criteria. Peritoneal tumor staging was performed using the peritoneal tumor index (PCI) scoring system, and a cell reduction degree (CCR) score was performed after CRS. CCR-0 and CCR-1 were considered satisfactory CRS.
RESULTS
A total of 186 patients with PMP were included, with a median age of 56 (48-64) years, 65 (34.9%) years in males, and 121 (65.1%) years in females. The median PCI score was 28 (20-34) points. The median operative time was 300 (211-430) minutes, and no significant complications occurred. 91.4% (170/186) were from the appendix, 53.2% (99/186) were from the low grade, and 30.6% (57/186) were from the high grade. CCR scores showed that 55 patients (29.6%) achieved satisfactory CRS, and 113 patients (60.8%) did not achieve satisfactory CRS. The fatality rate at 30 days after surgery was 2.7% (5/186), 1.6% (3/186) needed a second operation, and the fatality rate at 90 days was 4.3% (8/186). The total incidence of III-IV complications was 43.0% (80/186), among which the higher incidence was mainly anemia (27.4%, 51/186), electrolyte disturbance (11.6%, 21/181), and albumin decrease (7.5%, 14/186). The main complications associated with abdominal surgery were gastrointestinal anastomotic leakage (2.2%, 4/186), abdominal hemorrhage (2.2%, 4/186), and abdominal infection (4.3%, 8/186). The median follow-up was 38.1 (95%CI: 31.2-45.1) months. The 5-year OS of PMP patients treated with CRS + HIPEC was 50.3% (95%CI: 40.7%-59.9%), and the median survival time was 66.1 (95%CI: 43.1-89.1) months. The results of the survival analysis showed that patients with a low pathological grade, a low PCI, and a satisfactory CCR score had a higher survival rate (all P < 0.05). 5-year OS was 88.9% (95%CI: 68.3%-100.0%) in CCR-0 patients, 77.6% (95%CI: 62.7%-92.5%) in CCR-1 patients, and 42.0% (95%CI: 29.5%-54.5%) in CCR-2/3 patients.
CONCLUSION
The application of CRS + HIPEC in PMP is safe and feasible, and the survival benefit is high, especially in those who achieve satisfactory CRS, which can significantly extend the OS.
Core Tip: This study analyzed the efficacy of cell reduction combined with intraperitoneal thermoperfusion chemotherapy in the treatment of peritoneal pseudomyxoma (PMP). We will observe and study this treatment method, compare its efficacy with traditional chemotherapy methods, and explore the possible mechanism of action and adverse reactions of this method. This study will provide new ideas and methods for the treatment of PMP.
