Department of Digestive Surgery, Centre Hospitalier Lyon Sud, Université Claude Bernard Lyon 1, Lyon, France.
Department of Digestive Surgery, Centre Hospitalier Universitaire de Montreal, Montreal, Quebec, Canada.
BJS Open. 2018 Sep 27;3(2):195-202. doi: 10.1002/bjs5.97. eCollection 2019 Apr.
Pseudomyxoma peritonei (PMP) is a rare clinical condition characterized by mucinous ascites, typically related to appendiceal or ovarian tumours. Current standard treatment involves cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), but recurrences occur in 20-30 per cent of patients. The aim of this study was to define the timing and patterns of recurrence to provide a basis for modifying follow-up of these patients.
This observational study examined a prospectively developed multicentre national database (RENAPE working group) to identify patients with recurrence after optimal CRS and HIPEC for PMP. Postoperative complications, long-term outcomes and potential prognostic factors were evaluated.
Of 1411 patients with proven PMP, 948 were identified who had undergone curative CRS and HIPEC. Among these patients, 229 first recurrences (24·2 per cent) were identified: 196 (20·7 per cent) occurred within the first 5 years (early recurrence) and 30 (3·2 per cent) occurred between 5 and 10 years. Three patients developed a first recurrence more than 10 years after the original treatment. The mean(s.d.) time to first recurrence was 2·36(2·21) years. Preoperative chemotherapy and high-grade pathology were significant factors for early recurrence. Overall survival for the entire group was 77·9 and 63·1 per cent at 5 and 10 years respectively. The principal site of recurrence was the peritoneum.
Recurrence of PMP was rare after 5 years and exceptional after 10 years.
假性黏液瘤腹膜（PMP）是一种罕见的临床病症，其特征为黏液性腹水，通常与阑尾或卵巢肿瘤有关。目前的标准治疗方法包括细胞减灭术（CRS）和腹腔热灌注化疗（HIPEC），但仍有 20-30%的患者会出现复发。本研究旨在明确复发的时间和模式，为这些患者的随访方案调整提供依据。
本观察性研究对一个前瞻性开发的多中心国家数据库（RENAPE 工作组）进行了检查，以确定在接受最佳 CRS 和 HIPEC 治疗 PMP 后发生复发的患者。评估了术后并发症、长期结局和潜在的预后因素。
在 1411 例确诊为 PMP 的患者中，确定了 948 例接受了根治性 CRS 和 HIPEC 治疗的患者。在这些患者中，有 229 例首次复发（24.2%）：196 例（20.7%）发生在首次治疗后的 5 年内（早期复发），30 例（3.2%）发生在 5-10 年内。3 例患者在首次治疗后 10 年以上首次复发。首次复发的平均（标准差）时间为 2.36（2.21）年。术前化疗和高级别病理学是早期复发的显著因素。整个组别的总体生存率分别为 5 年时的 77.9%和 10 年时的 63.1%。复发的主要部位是腹膜。
PMP 在 5 年后复发罕见，10 年后复发罕见。
