Abstract
Pleural spread occurs in pseudomyxoma peritonei (PMP) in less than 10% of the patients and is treated by thoracic cytoreductive surgery with or without hyperthermic intrathoracic chemotherapy (HITOC). It is performed both for symptom palliation and disease control and includes pleurectomy and decortication and wedge and segmental lung resections. So far, only unilateral spread treated with a thoracic cytoreductive surgery (CRS) has been reported in literature. We report a patient with bilateral thoracic PMP following a complete abdominal CRS and hyperthermic intraperitoneal chemotherapy (HIPEC) who was treated with bilateral staged thoracic CRS and subsequently had a 4th CRS for abdominal disease. The staged procedure was performed as she was symptomatic due to the thoracic disease and there was disease on all pleural surfaces. HITOC was not performed. Both procedures were uneventful with no major morbidity. The patient is currently disease free nearly 84 months after the first abdominal CRS and 60 months after the second thoracic CRS. Thus, an aggressive CRS in the thorax in patients with PMP can result in a prolongation of survival while preserving the quality of life if the abdominal disease is controlled. A thorough understanding of the disease biology and surgical expertise are both essential for selecting the right patients for these complex procedures and achieving good short- and long-term outcomes.
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References
Pestieau SR, Esquivel J, Sugarbaker PH (2000) Pleural extension of mucinous tumor in patients with pseudomyxoma peritonei syndrome. Ann Surg Oncol 7(3):199–203. https://doi.org/10.1007/BF02523654
Kawaguchi Y, Hanaoka J, Ohshio Y, Okamoto K, Kaku R, Hayashi K, Shiratori T, Yoden M (2019) Patient survival after surgical management in intrathoracic pseudomyxoma peritonei. Ann Surg Oncol 26(1):238–243. https://doi.org/10.1245/s10434-018-6991-7
Ababneh R, Piso P, Hofmann HS, Dumitrovici A, Buiga R, Samasca G, Burz C (2016) An invasive treatment of pseudomyxoma peritonei with intrathoracic involvement. Maedica (Buchar) 11:72–75
Mortman KD, Sugarbaker PA, Shmookler BM, DeGzman VC, Soberman MS (1997) Pulmonary metastasis in pseudomyxoma peritonei syndrome. Ann Thorac Surg 64:1434–1436
Geisinger KR, Levine EA, Shen P, Bradley RF (2007) Pleuropulmonary involvement in pseudomyxoma peritonei. Morphologic assessment and literature review. Am J Clin Pathol 127:135–43
Kitai T (2012) Pulmonary metastasis from pseudomyxoma peritonei. Gastroenterol Res Pract. https://doi.org/10.1155/2012/690256
Bhatt A, Mishra S, Parikh L, Glehen O (2020) The pathological spectrum of mucinous appendiceal tumours and pseudomyxoma peritonei. In: Glehen, O., Bhatt, A. (eds) Pathology of peritoneal metastases. Springer, Singapore. https://doi.org/10.1007/978-981-15-3773-8_7
Chua TC, Yan TD, Yap ZL, Horton MD, Fermanis GG, Morris DL (2009) Thoracic cytoreductive surgery and intraoperative hyperthermic intrathoracic chemotherapy for pseudomyxoma peritonei. J Surg Oncol 99(5):292–295. https://doi.org/10.1002/jso.21230
Baratti D, Kusamura S, Guaglio M, Milione M, Pietrantonio F, Cavalleri T, Morano F, Deraco M (2023) Relapse of pseudomyxoma peritonei after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: pattern of failure, clinical management and outcomes. Ann Surg Oncol 30(1):404–414. https://doi.org/10.1245/s10434-022-12367-6
Mohamed F, Chang D, Sugarbaker PH (2003) Third look surgery and beyond for appendiceal malignancy with peritoneal dissemination. J Surg Oncol 83(1):5–12. https://doi.org/10.1002/jso.10234. (discussion 12-3)
Patel MD, Damodaran D, Rangole A, Shaikh S, Shah K, Bagwade R, Bhatt A (2019) Hyperthermic intrathoracic chemotherapy (HITHOC) for pleural malignancies-experience from Indian centers. Indian J Surg Oncol 10(Suppl 1):91–98. https://doi.org/10.1007/s13193-018-0859-y
Strach MC, Sutherland S, Horvath LG, Mahon K (2022) The role of chemotherapy in the treatment of advanced appendiceal cancers: summary of the literature and future directions. Ther Adv Med Oncol 14:17588359221112478. https://doi.org/10.1177/17588359221112478
Govaerts K, Lurvink RJ, De Hingh IHJT, Van der Speeten K, Villeneuve L, Kusamura S, Kepenekian V, Deraco M, Glehen O, Moran BJ, PSOGI (2021) Appendiceal tumours and pseudomyxoma peritonei: literature review with PSOGI/EURACAN clinical practice guidelines for diagnosis and treatment. Eur J Surg Oncol 47(1):11–35. https://doi.org/10.1016/j.ejso.2020.02.012
Blackham AU, Swett K, Eng C, Sirintrapun J, Bergman S, Geisinger KR, Votanopoulos K, Stewart JH, Shen P, Levine EA (2014) Perioperative systemic chemotherapy for appendiceal mucinous carcinoma peritonei treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. J Surg Oncol 109(7):740–5. https://doi.org/10.1002/jso.23547
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Mehta, S., Kammar, P., Sukumar, V. et al. Bilateral Thoracic Cytoreductive Surgery for Pseudomyxoma Peritonei of Appendiceal Origin. Indian J Surg Oncol 14 (Suppl 1), 161–165 (2023). https://doi.org/10.1007/s13193-023-01745-5
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DOI: https://doi.org/10.1007/s13193-023-01745-5