Pseudomyxoma peritonei surgery: Difference between revisions

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{{Pseudomyxoma peritonei}}
{{Pseudomyxoma peritonei}}
{{CMG}}{{AE}}{{PSD}}
{{CMG}}{{AE}}{{Nnasiri}}{{PSD}}
==Overview==
==Overview==
Pseudomyxoma peritonei is a rare clinical syndrome characterized by the accumulation of [[ascites]] and [[Mucin|mucins]] in the [[peritoneum]], mainly arising from the [[appendix]]. The mainstay of therapy in patients with pseudomyxoma peritonei is cytoreductive surgery combined with [[intraperitoneal]] [[Chemotherapy|chemotherapeutic infusion]].


==Surgery==
==Surgery==
*Surgery is the mainstay of treatment for pseudomyxoma peritonei. The feasibility of surgery depends on the stage of pseudomyxoma peritonei at diagnosis.  
*[[Surgery]] is the mainstay of treatment for pseudomyxoma peritonei. The traditional approach was repeated surgical [[debulking]], feasibility of [[surgery]] depends on the stage of pseudomyxoma peritonei at [[diagnosis]].<ref name="pmid17036382">{{cite journal |vauthors=Qu ZB, Liu LX |title=Management of pseudomyxoma peritonei |journal=World J. Gastroenterol. |volume=12 |issue=38 |pages=6124–7 |date=October 2006 |pmid=17036382 |pmc=4088104 |doi= |url=}}</ref>
*A more aggressive approach by Sugarbaker utilizes peritonectomy and visceral resections, called cytoreductive surgery (CRS), in combination with hyperthermic intraperitoneal chemotherapy (HIPEC) that is featured by direct targeting of the microscopic disease, locoregional drug availability, minimal systemic exposure and improved drug penetration through hyperthermia.<ref name="AminiMasoumi-Moghaddam2014">{{cite journal|last1=Amini|first1=Afshin|last2=Masoumi-Moghaddam|first2=Samar|last3=Ehteda|first3=Anahid|last4=Morris|first4=David|title=Secreted mucins in pseudomyxoma peritonei: pathophysiological significance and potential therapeutic prospects|journal=Orphanet Journal of Rare Diseases|volume=9|issue=1|year=2014|pages=71|issn=1750-1172|doi=10.1186/1750-1172-9-71}}</ref>  
*A more aggressive approach is called cytoreductive surgery (CRS), in combination with [[Hyperthermic intraperitoneal chemoperfusion|hyperthermic intraperitoneal chemotherapy]] (HIPEC) which has following advantage:
*When appropriate, surgery may include intraperitoneal hyperthermic chemotherapy, or post operative systemic chemotherapy.
**Targeting of the microscopic disease
*In situations where surgery is not required immediately, patients can be monitored via CT scans, tumor marker laboratory tests, and physical symptoms, to determined when, and if, surgery is warranted.
**Minimal systemic exposure and less toxicity
*Although some surgical procedures may be rather extensive, patients can and do recover from surgery, and the majority of these patients can and do live productive lives.
**Improved [[Chemotherapy|chemotherapeutic drug]] penetration by warming to 42 degree centigerade and direct [[Peritoneum|peritoneal]] infusion.<ref name="pmid19567401">{{cite journal |vauthors=Vaira M, Cioppa T, DE Marco G, Bing C, D'Amico S, D'Alessandro M, Fiorentini G, DE Simone M |title=Management of pseudomyxoma peritonei by cytoreduction+HIPEC (hyperthermic intraperitoneal chemotherapy): results analysis of a twelve-year experience |journal=In Vivo |volume=23 |issue=4 |pages=639–44 |date=2009 |pmid=19567401 |doi= |url=}}</ref><ref name="pmid21874418">{{cite journal |vauthors=Kitai T, Kawashima M, Yamanaka K, Ichijima K, Fujii H, Mashima S, Shimahara Y |title=Cytoreductive surgery with intraperitoneal chemotherapy to treat pseudomyxoma peritonei at nonspecialized hospitals |journal=Surg. Today |volume=41 |issue=9 |pages=1219–23 |date=September 2011 |pmid=21874418 |doi=10.1007/s00595-010-4495-6 |url=}}</ref>
*In debulking, the surgeon attempts to remove as much tumor as possible, while cytoreductive surgery involves surgical removal of the [[peritoneum]] and any adjacent organs which appear to have tumor seeding.
*Since the mucus tends to pool at the bottom of the abdominal cavity, it is common to remove the [[ovaries]], [[fallopian tubes]], [[uterus]], and parts of the [[large intestine]]. 
*Depending upon the spread of the tumor, other organs might be removed, including but not limited to the [[gallbladder]], [[spleen]], and all or portions of the  [[small intestine]] and/or [[stomach]]. 
*For organs that cannot be removed safely (like the [[liver]]), the surgeon strips off the tumor from the surface. <ref name=Harmon_2005>{{cite journal |author=Harmon R, Sugarbaker P |title=Prognostic indicators in peritoneal carcinomatosis from gastrointestinal cancer |journal=Int Semin Surg Oncol |volume=2 |issue=1 |pages=3 |year=2005 |url=http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=549516 |pmid=15701175}}</ref>


== References ==
== References ==
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Latest revision as of 13:34, 3 April 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Nima Nasiri, M.D.[2]Parminder Dhingra, M.D. [3]

Overview

Pseudomyxoma peritonei is a rare clinical syndrome characterized by the accumulation of ascites and mucins in the peritoneum, mainly arising from the appendix. The mainstay of therapy in patients with pseudomyxoma peritonei is cytoreductive surgery combined with intraperitoneal chemotherapeutic infusion.

Surgery

  • Surgery is the mainstay of treatment for pseudomyxoma peritonei. The traditional approach was repeated surgical debulking, feasibility of surgery depends on the stage of pseudomyxoma peritonei at diagnosis.[1]
  • A more aggressive approach is called cytoreductive surgery (CRS), in combination with hyperthermic intraperitoneal chemotherapy (HIPEC) which has following advantage:
    • Targeting of the microscopic disease
    • Minimal systemic exposure and less toxicity
    • Improved chemotherapeutic drug penetration by warming to 42 degree centigerade and direct peritoneal infusion.[2][3]

References

  1. Qu ZB, Liu LX (October 2006). "Management of pseudomyxoma peritonei". World J. Gastroenterol. 12 (38): 6124–7. PMC 4088104. PMID 17036382.
  2. Vaira M, Cioppa T, DE Marco G, Bing C, D'Amico S, D'Alessandro M, Fiorentini G, DE Simone M (2009). "Management of pseudomyxoma peritonei by cytoreduction+HIPEC (hyperthermic intraperitoneal chemotherapy): results analysis of a twelve-year experience". In Vivo. 23 (4): 639–44. PMID 19567401.
  3. Kitai T, Kawashima M, Yamanaka K, Ichijima K, Fujii H, Mashima S, Shimahara Y (September 2011). "Cytoreductive surgery with intraperitoneal chemotherapy to treat pseudomyxoma peritonei at nonspecialized hospitals". Surg. Today. 41 (9): 1219–23. doi:10.1007/s00595-010-4495-6. PMID 21874418.


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