Langenbeck's Archives of Surgery

, Volume 403, Issue 8, pp 985–990 | Cite as

Cellularity in low-grade Pseudomyxoma peritonei impacts recurrence-free survival following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

  • Philipp HorvathEmail author
  • Can Yurttas
  • Philipp Birk
  • Florian Struller
  • Alfred Königsrainer



Documentation of cellularity in Pseudomyxoma peritonei (PMP) is not performed on a regular basis in everyday clinical practice, but is recommended by the PSOGI (Peritoneal Surface Oncology Group International). We investigated the impact of cellularity in PMP following cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) on recurrence-free survival.


Data from 25 patients with low-grade (American Joint Committee on Cancer grade G1) PMP were retrospectively evaluated. Cellularity was categorized as acellular mucin, scant (< 2% cellularity), moderate (2–19% cellularity), or high cellularity (> 20% cellularity). Impact of cellularity, PCI, CC-score, and HIPEC regimen on recurrence-free and overall survival was primarily assessed.


Assessment of cellularity showed acellular mucin in ten patients (40%), scant cellularity in 11 (44%) patients, moderate cellularity in one (4%) patient, and high cellularity in three (12%) patients. Median PCI was 15 (range, 1–39). A CC-0 score was achieved in 13 (52%) patients and a CC-1 score was achieved in 12 (48%) patients. After a median follow-up of 25 (range, 2–74) months, all patients were still alive. Overall, four (16%) patients suffered from recurrent disease after a median of 38 (range, 36–60) months. PCI above 17 (p = 0.03) and moderate and high cellularity (p = 0.007) were statistically significantly associated with recurrent disease. CC-score and HIPEC compound used did not impact on recurrence-free survival.


Recurrent disease occurs more often in patients with PCI values above 17 and with moderate and high cellularity in low-grade PMP. Pathological assessment of cellularity is crucial for identification of patients at risk for recurrence.


Pseudomyxoma peritonei Low-grade Cellularity HIPEC Recurrence 


Authors’ contribution

Can Yurttas: analysis and interpretation of data, critical review of the manuscript; Alfred Königsrainer: critical review of the manuscript, analysis and interpretation of data; Philipp Horvath: acquisition of data, drafting of the manuscript, analysis and interpretation of data; Philipp Birk: critical review of the manuscript; Florian Struller: critical review of the manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Philipp Horvath
    • 1
    Email author
  • Can Yurttas
    • 1
  • Philipp Birk
    • 1
  • Florian Struller
    • 1
  • Alfred Königsrainer
    • 1
  1. 1.Department of General, Visceral and Transplant SurgeryUniversity of Tübingen, Comprehensive Cancer CenterTübingenGermany

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