OPTIMAL CYTOREDUCTION ASSOCIATED WITH HIPEC: A BENEFICIAL TREATMENT FOR PSEUDOMYXOMA PERITONEI IN SELECTED CASES

Case Presentation A 61-year-old female, under oncological follow-up for mucinous neoplasm of the appendix since 2018, developed pseudomyxoma peritonei. She underwent two lines of chemotherapy treatment, which had to be interrupted in 2022 due to severe toxicity. She developed an increase in carcinoembryonic antigen (CEA) after suspension of systemic treatment, along with worsening abdominal pain, associated with a palpable tumor. In the intraoperative period, a peritoneal carcinomatosis index (PCI) of 13 was identified, and she underwent total resection of the right diaphragm peritoneum and partial resection of the left diaphragm, resection of the caudate lobe, falciform ligament, pelvic peritoneum, implants from the hepatic capsule, abdominal wall, and sigmoid, in addition to splenectomy, omentectomy, cholecystectomy, and total hysterectomy. Optimal cytoreduction and hyperthermic intraperitoneal chemotherapy (HIPEC) were performed, with good clinical progression and hospital discharge on the seventh postoperative day. She required readmission after 30 days due to a collection in the splenectomy pouch, diagnosed as a pancreatic fistula, which was drained by radiointervention, with improvement after antibiotic therapy. She is currently under outpatient follow-up, with resolution of the collection in a control CT scan and no abdominal complaints.

Discussion Pseudomyxoma peritonei is the progressive accumulation of mucinous ascites in the abdominal cavity, highly associated with mucinous neoplasms of the cecal appendix. Its incidence is low, with 1-3 cases per million inhabitants. Initially, disseminated peritoneal disease was synonymous with a terminal condition and exclusive palliative treatment. However, in selected cases, it is possible to perform cytoreductive surgery, which involves complete resection of macroscopic lesions, combined with HIPEC, aimed at eradicating microscopic tumor lesions, thereby subjecting the patient to curative-intention treatment. For this, it is necessary to evaluate the patient's baseline conditions, the type of tumor, its response to chemotherapy, and the PCI. It is a major surgery with high morbidity and mortality, so careful patient selection is required to ensure therapeutic benefit.

Conclusion Patients with good performance status and low peritoneal carcinomatosis index are the best candidates for cytoreduction and HIPEC.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025