Clinical findings of patients with pseudomyxoma peritonei of appendiceal origin undergoing Cytoreductive surgery (CRS) a
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LETTER TO THE EDITOR
Clinical findings of patients with pseudomyxoma peritonei of appendiceal origin undergoing Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) Christos Iavazzo1 · John Spiliotis2,3 Received: 18 May 2020 / Accepted: 21 June 2020 © Italian Society of Surgery (SIC) 2020
To the Editor, With great deal of interest we read the article entitled “Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in pseudomyxoma peritonei (PMP) of appendiceal origin: result of a single centre study.” by Di Leo et al. [1] In the study, 32 patients were included during the period 2008–2016. Two thirds of them underwent first look surgery. In the cohort, the median operative time was 540 min and the median PCI index was 17. Complete cytoreduction (CC-0) was achieved in 69% of patients, and CC-1 in another 23%. Based on Clavien–Dindo classification, 3/32 patients had grade III complications (one with a porta-cath infection and two with pleural efusion), 1/32 had a grade IV complication (cerebral hematoma) and no grade V complications were identified. The median hospital stay was 9.5 days. In the cohort, one-year overall survival (OS) was 90% and 5-year OS was 58%. Disease-free survival (DFS), regardless of histological type, was 95% at 1 year and 46% at 5 years. A strong correlation was identified between higher initial PCI index, and 5-year OS. The aim of our letter is to highlight the significant role of CRS and HIPEC in the treatment of patients with pseudomyxoma peritonei of appendiceal origin which is strongly related to histology of pseudomyxoma peritonei of appendiceal origin and the achieved level of completeness of cytoreduction.
* Christos Iavazzo [email protected] 1
Department of Gynecological Oncology, Metaxa Cancer Hospital, Piraeus, Greece
2
Department of Surgical Oncology and HIPEC, Athens Medical Centre, Athens, Greece
3
Department of Surgical Oncology and HIPEC, European Interbalkan Medical Centre, Thessaloniki, Greece
For this reason, we would like to present the preliminary clinical results of our retrospective study evaluating a larger but similar cohort of patients. More specifically, in our cohort (study period 2005–2019), 111 patients were included. Their median age was 52.5 years (range 28–72 years). Among them, there are 62 female (55.8%) and 49 male patients (44.2%). All of them underwent first look therapeutic surgery. The minority of our cases were high grade mucinous adenocarcinomas n = 44 (39.6%). The median operative time was 480 min (ranging 310–670 min) and the median PCI index was 18 (ranging 9–27). The operative time was related to the learning curve. Complete cytoreduction (CC-0) was achieved in 63% of patients, and CC-1 in another 17%. A strong relationship was found between the PCI and the completeness of cytoreduction [ρ-Spearman (111) = 0.770, p
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