Elias Dominique, Laurent Stanislas, Antoun Samy, Duvillard Pierre, Ducreux Michel, Pocard Marc, Lasser Philippe
Département de Chirurgie Générale Carcinologique, Institut Gustave Roussy, rue Camille Desmoulins, 94805, Villejuif Cedex.
Gastroenterol Clin Biol. 2003 Apr;27(4):407-12.
Pseudomyxoma peritonei remains a fatal disease. This clinical pathological entity based on the presence of mucin includes different prognostic groups. Complete resection of macroscopic lesions, combined with immediate intraperitoneal chemotherapy to treat remnant infra-millimetric disease, might improve survival. The aim of this prospective study was to evaluate this treatment strategy.
Thirty-six patients with pseudomyxoma peritonei underwent resection of supra-millimetric lesions then were given either early postoperative intraperitoneal chemotherapy (5 days) (before January 1996) or intraoperative chemohyperthermia treatment (after January 1996). During this same period, only partial resection of the macroscopic lesion was possible in 15 patients; these patients were not given peritoneal chemotherapy.
Postoperative mortality was 13.8% (n=5), including 2 deaths not specifically due to the procedure. Morbidity, including severe and non-severe complications was 44%. After a mean follow-up of 48 months, the overall 5-years survival rate was 66%, and disease-free survival rate was 55% (including the postoperative deaths). The main prognostic factor in this series was the pathological grading: 5-years survival was 74% for grade 1 tumors versus 54% for grades 2-3 (P=0.05).
The main prognostic factor of the pseudomyxoma peritonei, after the completeness of the resection, is the pathological grading. The addition of an intraperitoneal chemohyperthermia improves long-term survival of grades 2-3 tumors and perhaps that of grade 1 (agreement of experts). This treatment is more easily performed, more well-tolerated, and more efficient when performed early.
腹膜假黏液瘤仍是一种致命性疾病。这种基于黏液存在的临床病理实体包含不同的预后组。完整切除肉眼可见病变，并联合立即进行腹腔内化疗以治疗残留的亚毫米级疾病，可能会提高生存率。这项前瞻性研究的目的是评估这种治疗策略。
36例腹膜假黏液瘤患者接受了大于毫米级病变的切除术，然后在术后早期接受了腹腔内化疗（5天）（1996年1月之前）或术中热化疗（1996年1月之后）。在同一时期，15例患者仅能进行肉眼可见病变的部分切除；这些患者未接受腹膜化疗。
术后死亡率为13.8%（n = 5），其中2例死亡并非手术直接导致。包括严重和非严重并发症在内的发病率为44%。平均随访48个月后，总体5年生存率为66%，无病生存率为55%（包括术后死亡病例）。该系列研究中的主要预后因素是病理分级：1级肿瘤的5年生存率为74%，而2 - 3级为54%（P = 0.05）。
腹膜假黏液瘤在切除完整性之后的主要预后因素是病理分级。术中热化疗的加入提高了2 - 3级肿瘤的长期生存率，对1级肿瘤可能也有提高（专家共识）。这种治疗方法操作更简便，耐受性更好，早期进行时效果更佳。
