Early results of surgery in 123 patients with pseudomyxoma peritonei from a perforated appendiceal neoplasm

• Published in: Diseases of the colon & rectum Vol. 50; no. 1; pp. 37 - 42
• Main Authors: MURPHY, Elizabeth M, SEXTON, Rosemary, MORAN, Brendan J
• Format: Conference Proceeding Journal Article
• Language: English
• Published: Secaucus, NJ Springer 2007; Lippincott Williams & Wilkins Ovid Technologies
• Subjects: Abdomen; Adult; Aged; Appendiceal Neoplasms - drug therapy; Appendiceal Neoplasms - pathology; Appendiceal Neoplasms - surgery; Biological and medical sciences; Biomarkers, Tumor - analysis; Combined Modality Therapy; Digestive system. Abdomen; Endoscopy; Female; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Other diseases. Semiology; Peritoneal Neoplasms - drug therapy; Peritoneal Neoplasms - pathology; Peritoneal Neoplasms - surgery; Postoperative Complications; Pseudomyxoma Peritonei - drug therapy; Pseudomyxoma Peritonei - pathology; Pseudomyxoma Peritonei - surgery; Rupture; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Antineoplastic agent; Human; Mitomycin; Effusion; Appendicitis; Laparoscopy; Malignant tumor; Intraperitoneal; Alkylating agent; Antibiotic; Histopathology; Treatment; Cross-sectional imaging; Abdominal disease; Surgery; Digestive diseases; Intestinal disease; Tumor; Endoscopy; Perforated appendiceal neoplasm; Ascites; Pseudomyxoma peritonei; Peritoneum
• ISSN: 0012-3706; 1530-0358
• DOI: 10.1007/s10350-006-0741-9

Epithelial appendiceal tumors are uncommon but can present as an emergency simulating appendicitis, or unexpectedly at laparotomy, laparoscopy, or on cross-sectional imaging. Occult rupture with features of pseudomyxoma peritonei may be encountered. We report the operative findings, pathologic assessment, and early outcomes in 123 consecutive patients with a perforated appendiceal neoplasm presenting as pseudomyxoma peritonei. From March 1994 to March 2004, 292 patients were referred to a peritoneal malignancy surgical treatment center. Complete tumor removal (cytoreduction) was attempted in selected patients and, if achieved, surgery was combined with intraoperative, intraperitoneal mitomycin C (10 mg/m(2)). In total, 123 patients (52 males; 41 percent) underwent laparotomy for a perforated appendiceal malignancy presenting as pseudomyxoma peritonei. The median age was 52 (range 30-77) years. Complete cytoreduction was achieved in 83 of 123 patients (67 percent), major palliative resection in 34 patients (28 percent), and 6 patients (5 percent) were inoperable. Postoperative mortality was 6 of 123 patients (5 percent). Kaplan-Meier analysis of the 83 patients who had complete tumor removal predicted 75 percent disease-free survival at five years. A perforated appendiceal epithelial tumor most frequently presents as pseudomyxoma peritonei. This treatment strategy, involving surgery and intraperitoneal chemotherapy, can result in good outcomes in this rare and otherwise fatal disease.