Background and objectives. After CRS-HIPEC, approximately 25-45% of patients with pseudomyxoma peritonei (PMP) experience recurrence even after optimal treatment. Treatment of recurrent PMP is controversial and based mainly on surgeon and center experience. The aim of this study was to assess the feasibility, safety, and oncological benefit of iterative CRS-HIPEC (i-CRS-HIPEC) in patients with recurrent PMP.
Methods. Consecutive PMP patients treated according to an institutionally standardized protocol of CRS-HIPEC were retrospectively analyzed for postoperative and long-term oncological outcomes.
Results. Between January 2010 and May 2023, 76 patients with PMP were treated with CRS and HIPEC. Of these, 21 patients underwent i-CRS-HIPEC for recurrent PMP and were compared with those who underwent primary surgery (p-CRS-HIPEC). Peritoneal Cancer Index (PCI), cytoreduction grade (CC), and histological grade (acellular mucin, low-grade, and high-grade PMP) didn’t differ significantly from primary CRS-HIPEC. Postoperative outcomes and complications were similar between the groups. After a median follow-up of 24.5 months (IQR 18.89-30.18), there was no difference between groups in the 5-year OS and DFS.
Conclusions. i-CRS-HIPEC can be performed safely and is associated with the same oncological outcome in terms of local disease control and should be considered the first choice for recurrent PMP after appropriate patient selection.