Primary peritonectomy/hipec for disseminated peritoneal adenomucinosis achieves much lower recurrence rates and better survival than secondary procedures

Background: Two main treatment options are available for pseudomyxoma peritonei (PMP) and disseminated peritoneal adenomucinosis (DPAM) — incomplete cytoreductive (debulking) surgery and peritonectomy with intraperitoneal chemotherapy. Several studies have demonstrated improved survival with peritonectomy. This study analyses outcome following peritonectomy in patients undergoing a primary procedure compared to those who have had previous debulks. Methods: Between April 1997 and May 2008, 63 patients underwent peritonectomy for DPAM — 38 had had previous debulk(s) and 25 underwent primary peritonectomy. Patients were followed-up at three- to six-monthly intervals postoperatively, with a mean follow-up time of 21 and 34 months, respectively. Results: Mean survival for patients undergoing primary peritonectomy was 109.8 months. Mean survival for patients with previous debulks was 49.2 months (p=0.027). Five-year survival was 95.5% in the primary peritonectomy group and 67.5% in the previous debulk group. Conclusion: Disease recurrence after primary peritonectomy for DPAM is significantly less frequent than after secondary peritonectomy.

Keywords: appendiceal neoplasms, cytoreduction, cytoreductive surgery, intraperitoneal chemotherapy, peritoneal neoplasms, peritonectomy, pseudomyxoma peritoneii

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