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Pseudomyxoma peritonei: A French multicentric study of 301 patients treated with cytoreductive surgery and intraperitoneal chemotherapy

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Pseudomyxoma peritonei: A French multicentric study of 301 patients treated with cytoreductive surgery and intraperitoneal chemotherapy
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  Accepted Manuscript Title: Pseudomyxoma peritonei: a French multicentric study of 301 patients treatedwith cytoreductive surgery and intraperitoneal chemotherapyAuthors: D. Elias, F. Gilly, F. Quenet, JM. Bereder, L. Sideris, B. Mansvelt, G.Lorimier, O. GlehenPII:S0748-7983(10)00031-4DOI:10.1016/j.ejso.2010.01.006Reference:YEJSO 2935To appear in: European Journal of Surgical Oncology  Received Date:11 November 2009Accepted Date:18 January 2010Please cite this article as: Elias D, Gilly F, Quenet F, Bereder JM, Sideris L, Mansvelt B, Lorimier G, Glehen O. Pseudomyxoma peritonei: a French multicentric study of 301 patients treated withcytoreductive surgery and intraperitoneal chemotherapy, European Journal of Surgical Oncology (2010),doi: 10.1016/j.ejso.2010.01.006This is a PDF file of an unedited manuscript that has been accepted for publication. As a service toour customers we are providing this early version of the manuscript. The manuscript will undergocopyediting, typesetting, and review of the resulting proof before it is published in its final form. Pleasenote that during the production process errors may be discovered which could affect the content, and alllegal disclaimers that apply to the journal pertain.      M   A    N    U   S   C    R     I    P    A   C   C    E    P    T    E    D ACCEPTED MANUSCRIPT  1 1                 D. Elias 1 , MD, PhD, F. Gilly 2 , MD, PHD, F. Quenet 3 , MD, JM. Bereder 4 , MD L. Sidris ! , MD, B. Mans"elt # , MD G. L$ri%ier & , MD '. Glehen 2 , MD, PhD, (nd the (ss$)iati$n Fran*aise de +hirurie 1 -nstitut Gusta"e $ussy, /ille0ui. 2 +enter H$sital$ni"ersitaire Ly$nsud 3 +enter /al d5(urel, M$ntellier 4 +enter H$sital$ni"ersitaire, 6i)e ! H$it7l Mais$nneu"e, M$ntral # H$ital J$li%$nt, Haine St Paul & +enter Paul Pain, (ners +$rres$ndin auth$r 8 D$%ini9ue EL-(S +hie  Deart%ent $ 'n)$l$i) Surery 3: ue +a%ille Des%$ulins :4;<!, /ille0ui, +de=, Fran)e e%ail8 elias>ir.r      M   A    N    U   S   C    R     I    P    A   C   C    E    P    T    E    D ACCEPTED MANUSCRIPT  2 2   ?he results $@tained in 3<1 atients Aith seud$%y=$%a erit$nei treated @y )yt$redu)ti"e surery )$%@ined Aith eri$erati"e intraerit$neal )he%$theray in 1; Fren)hseain )enters )$nir%s $$d results and that these r$)edures sh$uld @e re)$%%ended in se)ialiCed )enters. !"#$!#"%& '(!"'$! )*   ?$ analyCe a lare series $ atients Aith seud$%y=$%a erit$nei PMP treated Aith )yt$redu)ti"e surery ass$)iated Aith eri$erati"e intraerit$neal )he%$theray P-+ in 1; Fren)hseain )enters.     Fr$% Mar)h 1::3 t$ De)e%@er 2<<&, 3<1 atients Aith diuse PMP Aere treated @y )yt$redu)ti"e surery Aith P-+. +$%lete )yt$redu)ti"e surery Aas a)hie"ed in 21: atients &3, and hyerther%i) intraerit$neal )he%$theray H-PE+ Aas er$r%ed in 2!! ;!, %ainly durin the latter eri$d $ the study. "  P$st$erati"e %$rtality and %$r@idity Aere 4.4 and 4<, rese)ti"ely. ?he %ean $ll$Au Aas ;; %$nths. ?he !year $"erall and diseaseree sur"i"al rates Aere &3 and !#, rese)ti"ely. ?he %ulti"ariate analysis identiied ! r$n$sti) a)t$rs 8 the e=tent $ erit$neal seedin <.<<4, the )enter <.<<<4, the ath$l$i) rade <.<3, ender <.<2, and the use $ H-PE+ <.<4. hen $nly the 2<# atients Aith )$%lete )yt$redu)ti"e surery Aere )$nsidered, the e=tent $ erit$neal seedin Aas the $nly sinii)ant r$n$sti) a)t$r <.<<4. $        M   A    N    U   S   C    R     I    P    A   C   C    E    P    T    E    D ACCEPTED MANUSCRIPT  3 3 ?his lare %ulti)entri) retr$se)ti"e study )$nir%s that )yt$redu)ti"e surery )$%@ined Aith P-+ Aith the use $ hyerther%ia sh$uld @e )$nsidered as the $ld standard treat%ent $ PMP and sh$uld @e er$r%ed in se)ialiCed )enters. -t underlines the r$n$sti) i%a)t $ the e=tent $ erit$neal seedin, ese)ially in atients treated @y )$%lete )yt$redu)ti"e surery. ?his r$n$sti) i%a)t aears t$ @e reater than that $ the ath$l$i) rade. +,  erit$neal seud$%y=$%a, )yt$redu)ti"e surery, intraerit$neal )he%$theray, hyerther%ia, r$n$sisI      M   A    N    U   S   C    R     I    P    A   C   C    E    P    T    E    D ACCEPTED MANUSCRIPT  4 4 Pseud$%y=$%a erit$nei PMP is a )lini)$ath$l$i) entity )hara)teriCed @y the r$du)ti$n $ %u)in$us as)ites 1,2 and %$stly $riinates r$% aendi)eal eithelial ne$las%s. ?he tu%$r r$As, $@stru)tin the narr$A lu%en $ the aendi= and su@se9uently leadin t$ aendi)eal er$rati$n 1,2. ?hen ne$lasti) )ells r$ressi"ely and sl$Aly )$l$niCe the erit$neal )a"ity and )$i$us %u)in r$du)ti$n @uilds u in the erit$neal )a"ity. e)ently, ath$l$i) enteri) @a)teria Aere sh$An t$ @e resent in all se)i%ens and their density Aas )$rrelated Aith the r$n$sis 3. (endi= tu%$rs )ausin PMP rane r$% a @enin ath$l$i) aearan)e disse%inated erit$neal aden$%u)in$sis $r DP(M, t$ %alinant ath$l$i) indins erit$neal %u)in$us )ar)in$%at$sis $r PM+(, Aith s$%e inter%ediate ath$l$i) rades 4. +lini)ally, this syndr$%e ranes r$% early PMP $rtuit$usly dis)$"ered $n i%ain $r durin a laar$t$%y er$r%ed $r an$ther reas$n, t$ ad"an)ed )ases Aith a distended a@d$%en, $))lusi"e syndr$%e and star"ati$n. ?he )$n"enti$nal treat%ent $ PMP is suri)al de@ulin reeated, as ne)essary t$ alle"iate ressure ee)ts !,#. H$Ae"er, this treat%ent is alliati"e, lea"in "isi@le $r $))ult disease in the erit$neal )a"ity. eeated de@ulin sureries @e)$%e e"er %$re dii)ult due t$ r$ressi"ely thi)ened intraa@d$%inal adhesi$ns &. ( )$%@inati$n $ )yt$redu)ti"e surery +S Aith eri$erati"e intraerit$neal )he%$theray P-+ Aas r$$sed @y Suar@aer ;. ?he rati$nale @ehind this stratey Aas t$ rese)t "isi@le disease and any $))ult residual disease A$uld @e treated Aith a hih )$n)entrati$n $ )he%$theray and hyerther%ia Ahi)h %utually $tentiate $ne an$ther5s ee)ts :,1<. Fiteen years and #<<   u@li)ati$ns later &, a syste%ati) re"ieA $ this n$"el treat%ent )$n)luded that this )$%@ined ar$a)h Aas "ery r$@a@ly sueri$r t$ )$n"enti$nal theray, e"en in the a@sen)e $ )$ntr$lled
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