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PubMed - Pseudomyxoma Peritonei (PMP) (13 unread)

Invited commentary.

Fetched: January 31st, 2010, 3:49pm CST

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Invited commentary.

Dis Colon Rectum. 2009 Oct;52(10):1714-5

Authors: Verwaal VJ

PMID: 19966602 [PubMed - indexed for MEDLINE]
Ovarian stimulation and emergency in vitro fertilization for fertility preservation in cancer patients.

Fetched: January 20th, 2010, 9:02am CST

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Ovarian stimulation and emergency in vitro fertilization for fertility preservation in cancer patients.

Eur J Obstet Gynecol Reprod Biol. 2010 Jan 12;

Authors: Michaan N, Ben-David G, Ben-Yosef D, Almog B, Many A, Pauzner D, Lessing JB, Amit A, Azem F

OBJECTIVE: To evaluate the outcome of ovarian stimulation and in vitro fertilization (IVF) in women undergoing fertility preservation prior to chemotherapy compared with healthy patients with infertility due to tubal factor. STUDY DESIGN: Case control, retrospective study in an academic IVF unit. The study participants were 21 cancer patients and 1 patient with focal proliferative glomerulosclerosis, undergoing emergency IVF or intracytoplasmic sperm injection (ICSI; Group A) and 22 patients undergoing IVF for tubal factor (Group B). All patients underwent controlled ovarian stimulation, ovum pick-up, and embryo freezing or transfer. The outcome measures included: dose of gonadotropins, mean estradiol and progesterone levels, length of stimulation, number of retrieved oocytes, number of 2 pronuclei zygotes, fertilization rate, and clinical pregnancy rate. Student's t-test was used for assessment of group comparisons. RESULTS: Patients in Group A (mean age 32.8+/-5.7 years) underwent 22 emergency IVF cycles for fertility preservation prior to chemotherapy. The mean number of days until human chorionic gonadotropin administration was 10.4+/-4.8. Eleven cycles involved normal insemination while nine involved ICSI. In one cycle three arrested immature oocytes were retrieved, and in one cycle no oocytes were retrieved. Donor sperm was used in 9 cycles. Tamoxifen was part of the treatment protocol in 6 IVF cycles of breast cancer patients. The mean age of the women in Group B was 34+/-4.2 years. There were no significant differences in any of the main outcome measures between the two groups. Thawed embryos were transferred in four cancer patients: two patients had colon cancer, one had breast cancer and one had pseudomyxoma peritonei. Two of these four women conceived and gave birth to healthy newborns. CONCLUSIONS: Emergency IVF is a promising approach for preserving fertility in cancer patients. Current treatment protocols offer a minimal time delay until chemotherapy is commenced, and the ovarian stimulation outcomes are comparable to those of women with tubal factor.

PMID: 20074845 [PubMed - as supplied by publisher]
Mucinous adenocarcinoma of the appendix presenting with atypical symptomatology and presence of pseudomyxoma peritonei: a case report.

Fetched: January 20th, 2010, 9:02am CST

Mucinous adenocarcinoma of the appendix presenting with atypical symptomatology and presence of pseudomyxoma peritonei: a case report.

Cases J. 2009;2:9089

Authors: Alexiou K, Sikalias N, Demonakou M, Mylona SC, Triantafyllis V, Kalogirou A, Antsaklis G

INTRODUCTION: Primary tumors of the appendix are unusual and most of them are carcinoids. Their main presentation is that of an acute appendicitis or as a palpable mass, mainly in the right lower quadrant. CASE PRESENTATION: A female patient with mucous adenocarcinoma of the appendix, which primarily presented as atypical abdominal pain. Diagnosis of the disease was made after appendicectomy and histopathological analysis of the specimen. The patient finally underwent a complementary right hemicolectomy. CONCLUSION: Mucin producing adenocarcinomas of the appendix are a category of rare cancers of the gastrointestinal tract. Although at present they are a well studied pathologic entity, the crucial issue of their preoperative diagnosis remains unsolved.

PMID: 20062726 [PubMed - in process]
Appendiceal mucocele mimicking a cystic right adnexal mass.

Fetched: January 10th, 2010, 2:30pm CST

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Appendiceal mucocele mimicking a cystic right adnexal mass.

Taiwan J Obstet Gynecol. 2009 Dec;48(4):412-4

Authors: Balci O, Ozdemir S, Mahmoud AS

OBJECTIVE: Appendiceal mucocele is formed by cystic dilatation, abnormal mucinous secretion and epithelial proliferation of the appendiceal lumen. Mucocele may be a finding in cases of benign or malignant neoplasms, and can lead to the development of pseudomyxoma peritonei. CASE REPORT: A 71-year-old woman presented with a 3-day history of right lower abdominal pain radiating to her right thigh. A simple 5 x 7 cm cyst with smooth borders and a thick capsule was detected in the right adnexal area by transvaginal ultrasonography. Magnetic resonance imaging identified a 4 x 8 cm cystic lesion in the area of the right ovary. The patient was admitted to our clinic with an initial diagnosis of adnexal cyst, later found to be appendiceal mucocele. CONCLUSION: The signs and symptoms of appendiceal mucocele are not specific. Because of its anatomic position, it should be considered in the differential diagnosis of adnexal masses.

PMID: 20045765 [PubMed - in process]
Evaluation of the Cost-Effectiveness of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (Peritonectomy) at the St George Hospital Peritoneal Surface Malignancy Program.

Fetched: January 1st, 2010, 4:56pm CST

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Evaluation of the Cost-Effectiveness of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (Peritonectomy) at the St George Hospital Peritoneal Surface Malignancy Program.

Ann Surg. 2009 Dec 24;

Authors: Chua TC, Martin S, Saxena A, Liauw W, Yan TD, Zhao J, Lok I, Morris DL

BACKGROUND:: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are treatment approaches for peritoneal carcinomatosis that has demonstrated improved survival outcomes with acceptable complication rates. This report aims to measure and describe the survival outcomes and health care cost associated with CRS and HIPEC for peritoneal surface malignancies at a centralized tertiary institution in Australia. METHODS:: The expenditure of treatment for 136 consecutive patients who underwent 159 CRS and HIPEC from June 2002 to June 2008 were obtained. Together with their survival outcomes from treatment, a cost-effectiveness analysis was performed. RESULTS:: The average cost of CRS and HIPEC per patient and per life year for appendix cancer is AUD $88,423 (range, AUD $23,933-AUD $299,145) and AUD $37,737/LY; for colorectal cancer is AUD $66,148 (range, AUD $26,079-AUD $409,666) and AUD $29,757/LY; for pseudomyxoma peritonei is AUD $92,308 (range, AUD $11,562-AUD $501,144) and AUD $29,559/LY; for peritoneal mesothelioma is AUD $55,062 (range, AUD $23,261-AUD $94,104) and AUD $20,521/LY; and for other peritoneal surface malignancies is AUD $44,668 (range, AUD $31,592-AUD $70,026) and AUD $22,091/LY. CONCLUSIONS:: This complex surgical treatment results in significant increases in medical costs with a parallel increase in survival for a disease that has been poorly treated, and hence may be considered as cost-effective given the observed life years gained.

PMID: 20040853 [PubMed - as supplied by publisher]
Critical Assessment of Risk Factors for Complications After Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy for Pseudomyxoma Peritonei.

Fetched: January 1st, 2010, 4:56pm CST

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Critical Assessment of Risk Factors for Complications After Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy for Pseudomyxoma Peritonei.

Ann Surg Oncol. 2009 Dec 29;

Authors: Saxena A, Yan TD, Chua TC, Morris DL

BACKGROUND: Cytoreductive surgery (CRS) combined with perioperative intraperitoneal chemotherapy (PIC) has demonstrated improved survival in selected patients with pseudomyxoma peritonei (PMP). However, this aggressive treatment modality has been consistently associated with variable rates of perioperative mortality between 0% and 18% and morbidity between 30% and 70%. This study evaluates the clinical and treatment-related risk factors for perioperative morbidity and mortality in PMP patients who underwent CRS and PIC. MATERIALS AND METHODS: A total of 145 consecutive CRS and PIC procedures for PMP performed between January 1996 and March 2009 were evaluated. The association of 12 clinical and 20 treatment-related risk factors with grades III and IV/V morbidity were assessed by univariable and multivariable analysis. RESULTS: The mortality (grade V) rate was 3%. The morbidity rates of grades III and IV were 23% and 22%, respectively. Eight factors were associated with grade IV/V morbidity on univariable analysis: peritoneal cancer index >/=21 (P = .034), ASA score >/=3 (P = .003), operation duration >/=10 h (P < .001), left upper quadrant peritonectomy procedure (P = .037), colonic resection (P = .012), ostomy (P = .005), ileostomy (P = .012), and transfusion >/=6 units (p = 0.011). Multivariable analysis showed 2 significant risk factors for grade IV/V morbidity: ASA >/= 3 (P = .006) and an operation length >/=10 h (P < .001). CONCLUSIONS: CRS and PIC has an acceptable rate of perioperative mortality and morbidity in selected patients with PMP. Patients with bulky disease who undergo a long operation are at a particularly high risk of a severe adverse event.

PMID: 20039212 [PubMed - as supplied by publisher]
Endometriosis with myxoid change mimicking pseudomyxoma peritonei.

Fetched: December 27th, 2009, 9:49am CST

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Endometriosis with myxoid change mimicking pseudomyxoma peritonei.

Pathology. 2010 Jan;42(1):95-7

Authors: Tang K, Lyons S, Valmadre S, Russell P

PMID: 20025493 [PubMed - in process]
Palliative Effects of an Incomplete Cytoreduction Combined With Perioperative Intraperitoneal Chemotherapy.

Fetched: December 22nd, 2009, 8:01am CST

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Palliative Effects of an Incomplete Cytoreduction Combined With Perioperative Intraperitoneal Chemotherapy.

Am J Clin Oncol. 2009 Dec 16;

Authors: Chua TC, Baker B, Yan TD, Zhao J, Morris DL

OBJECTIVES:: Incomplete cytoreduction often occurs because of overwhelming burden of disease intraperitoneally that limit a successful cytoreduction. The outcome of an incomplete cytoreduction followed by administering perioperative intraperitoneal chemotherapy on whether it prolongs survival or palliates symptoms is yet to be established. METHODS:: A retrospective review of a prospectively collected database was performed. Eleven patients were identified to have had an incomplete (CC2/3) cytoreduction and received either hyperthermic intraperitoneal chemotherapy or early postoperative intraperitoneal chemotherapy. The symptoms of the patients before and after treatment during follow-up consultations in clinic were noted. Survival analysis was performed using the Kaplan Meier method. RESULTS:: The median follow-up period was 19 (range, 0.5-35) months. The overall median survival was 21 months with a 1- and 2-year survival rate of 72% and 36%, respectively. Five of 7 patients with pseudomyxoma peritonei and 2 of 3 patients with colorectal cancer peritoneal carcinomatosis experienced symptom improvement after treatment. Severe postoperative morbidity and achieving symptomatic improvement following treatment seems to be associated with a dismal prognosis. CONCLUSION:: Our results suggest that some patients derive a survival and symptomatic benefits despite an incomplete cytoreductive surgery and perioperative intraperitoneal chemotherapy. The effects of this treatment require further investigation to determine its benefits as a palliative procedure.

PMID: 20019578 [PubMed - as supplied by publisher]
Mucocele of the Appendix - A Heterogenous Surgical Pathology.

Fetched: December 22nd, 2009, 8:01am CST

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Mucocele of the Appendix - A Heterogenous Surgical Pathology.

Zentralbl Chir. 2009 Dec 7;

Authors: Kleemann M, Laubert T, Krokowski M, Eckmann C, Bruch HP, Kujath P

BACKGROUND: Mucoceles of the appendix are rare. After appendectomy, mucoceles are detected with a frequency of 0.2 to 0.3 %. Both stenosing / obliterating processes and alterations of the epithelium (hyperplasia, mucinous cystadenoma, cystadenoma with uncertain malignant potential (UMP), mucinous cystadenocarcinoma lead to the occurrence of mucoceles. The perforation of a muco-cele with possible spread of mucus and cells into the abdominal cavity constitutes a severe complication (pseudomyxoma peritonei). Surgical resection is the curative approach for muco-celes of the appendix. MATERIALS AND MATHODS: Data of patients who were treated for an appendiceal mucocele be-tween 1995 and 2009 were analysed retros-pec-tively with regard to clinical presentation, diagnostic measures, surgical procedure and histopathological result. Follow-up was evaluated in telephone interviews. RESULTS: We extracted 5 cases from our database. Clinical symptoms varied greatly among the individual patients, ranging from peracute abdominal pain in the right lower quadrant to chronic obstipation. Results from abdominal ultrasound and / or abdominal CT scans contributed to the indica-tion for surgical intervention in all cases. In 2 pa-tients surgery was stated as urgent whereas in 3 the operation was scheduled electively. In one -pa-tient the diagnosis of an appendiceal mucocele was stated preoperatively and in another intra-operatively. In 3 patients only the histopathological result revealed the underlying mucocele. We performed 1 open and 1 laparoscopic appendectomy, 1 open appendectomy with a partial resection of the coecum and 2 laparoscopic ileocoecal resections. One of the patients had a pseudo-myxoma peritonei. The histopathological diagnoses ranged from mere epithelial hyperplasia to an adenoma with uncertain malignant potential and a mucinous cystadenocarcinoma. One patient's long-term follow-up could not be evaluated. All other patients had neither recurrence nor any complications after discharge. CONCLUSIONS: Mucoceles of the appendix present with a wide spectrum of clinical symptoms and histopathological alterations. Only an accurate histological analysis reveals the underlying pathological lesion correctly. This study emphasises that a mucocele of the appendix constitutes an important differential diag-nosis in patients presenting with pathologies in their right lower abdominal quadrant.

PMID: 19998220 [PubMed - as supplied by publisher]
The second procedure combining complete cytoreductive surgery and intraperitoneal chemotherapy for isolated peritoneal recurrence: postoperative course and long-term outcome.

Fetched: December 22nd, 2009, 8:01am CST

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The second procedure combining complete cytoreductive surgery and intraperitoneal chemotherapy for isolated peritoneal recurrence: postoperative course and long-term outcome.

Ann Surg Oncol. 2009 Oct;16(10):2744-51

Authors: Brouquet A, Goéré D, Lefèvre JH, Bonnet S, Dumont F, Raynard B, Elias D

BACKGROUND: Complete cytoreductive surgery (CCRS) with intraperitoneal chemotherapy (IPC) is becoming the gold-standard treatment for resectable peritoneal carcinomatosis, when feasible. However, this approach has not yet been evaluated for isolated peritoneal re-recurrences after previous IPC. The aim of this study was to evaluate the postoperative course and long-term outcome after repeat (re-)CCRS + IPC. METHODS: From 1996 to 2007, 25 re-CCRS + IPC were performed in 20 patients with isolated peritoneal re-recurrences, among 393 CCRS + IPC performed during the same period in the department. Selection was based on the supposedly limited extent of the peritoneal disease and an interval of more than 12 months between the first CCRS + IPC procedure and recurrence. After a re-CCRS, we used re-IPC modalities (method and/or drug) that were systematically different from those of the first IPC. The origins of the tumors were pseudomyxoma (n = 12), colorectal cancer (n = 4), mesothelioma (n = 3), and carcinoid tumor (n = 1). RESULTS: At laparotomy, mean peritoneal index was 7.6 +/- 4.8. Among the 25 procedures, hyperthermic intraperitoneal chemotherapy was used in 15 cases and early postoperative intraperitoneal chemotherapy in 10 cases. The postoperative mortality rate was 4% (n = 1) and six grade 3-4 postoperative complications occurred. The overall 5- and 10-year actuarial survival rates were 72.5% and 58%, respectively. The 5-year disease-free survival rate was 19%. The long-term outcome was not different, whatever the type of primary tumor. CONCLUSION: Re-CCRS + IPC is feasible and yields prolonged survival in highly selected patients. Also, the switch to another type of IPC or regimen may have contributed to this prolonged survival.

PMID: 19626375 [PubMed - indexed for MEDLINE]
[The techniques of peritonectomy and hyperthermic intraperitoneal chemotherapy]

Fetched: December 22nd, 2009, 8:01am CST

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[The techniques of peritonectomy and hyperthermic intraperitoneal chemotherapy]

Zentralbl Chir. 2009 Sep;134(5):443-9

Authors: Lang SA, Glockzin G, Dahlke MH, Popp FC, Agha A, Schlitt HJ, Piso P

The treatment of peritoneal carcinomatosis represents a challenge in the therapy for gastrointestinal cancer. A multimodal approach with complete surgical cytoreduction and hyperthermic intraperitoneal chemotherapy can improve the prognosis in selected patients. Complete surgical cytoreduction, consisting of parietal and visceral peritonectomy, is a sophisticated procedure, frequently requiring multivisceral resections and should only be performed by experienced visceral surgeons. In addition, hyperthermic intraperitoneal chemotherapy is of some complexity. Furthermore, regarding the learning curve for this procedure, combined treatment should only be performed in specialised centres. Under optimal conditions, the therapy can be carried out with reasonable morbidity and mortality rates. Patients with peritoneal carcinomatosis should be evaluated by an interdisciplinary team concerning this multimodal therapy option and, if applicable, they should be referred to therapy within the framework of clinical studies.

PMID: 19492282 [PubMed - indexed for MEDLINE]
Treatments and outcomes of peritoneal surface tumors through a centralized national service (United kingdom).

Fetched: December 9th, 2009, 7:36am CST

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Treatments and outcomes of peritoneal surface tumors through a centralized national service (United kingdom).

Dis Colon Rectum. 2009 Oct;52(10):1705-14

Authors: Rout S, Renehan AG, Parkinson MF, Saunders MP, Fulford PE, Wilson MS, O'Dwyer ST

PURPOSE: Treatment of peritoneal surface malignancies with combined cytoreductive surgery and heated intraperitoneal chemotherapy may improve oncologic outcome. To better define treatment pathways, five-year results in patients referred to one of two centralized national treatment centers in the United Kingdom were analyzed. METHODS: A prospective database of patients referred to the Manchester Peritoneal Tumor Service, established in 2002, was analyzed. Outcomes were evaluated using Kaplan-Meier life tables and Cox models. RESULTS: Two hundred seventy-eight patients (median age, 56.9 (range, 16-86) years) were considered by a dedicated multidisciplinary team and tracked on seven clinical pathways. Among the 118 surgically treated, the most common diagnosis was pseudomyxoma peritonei (101 patients, 86%). Major complications occurred in 11 patients (9%); there was no 30-day mortality. Where complete cytoreduction was achieved, three-year and five-year tumor-related survival rates were 94% and 86%, respectively. In the Cox model, incompleteness of cytoreduction (P = 0.001) and high-grade tumor (P < 0.0001) were independent prognosticators of poor outcome. CONCLUSION: The establishment of a national treatment center has allowed refinement of techniques to achieve internationally recognized results. Having achieved low levels of morbidity and mortality in the treatment of mainly pseudomyxoma peritonei of appendiceal origin, the technique of cytoreductive surgery and heated intraperitoneal chemotherapy may be considered for peritoneal carcinomatosis of colorectal origin.

PMID: 19966601 [PubMed - in process]
Pseudomyxoma peritonei presenting as inguinal hernia.

Fetched: November 27th, 2009, 11:18am CST

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Pseudomyxoma peritonei presenting as inguinal hernia.

Ulster Med J. 2009 Sep;78(3):189-90

Authors: Campbell P, Dawson S, Wali J, Kenny B, Whiteside MC

PMID: 19907691 [PubMed - in process]