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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
ORIGINAL ARTICLE

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Pseudomyxoma peritonei Low-grade Cellularity HIPEC Recurrence 

Notes

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.

References

  1. 1.
    Carr NJ, Cecil TD, Mohamed F, Sobin LH, Sugarbaker PH, González-Moreno S, Taflampas P, Chapman S, Moran BJ (2016) A consensus for classification and pathologic reporting of Pseudomyxoma Peritonei and associated appendiceal neoplasia: the results of the Peritoneal Surface Oncology Group International (PSOGI) Modified Delphi Process. Am J Surg Pathol 40(1):14–26.  https://doi.org/10.1097/PAS.0000000000000535 CrossRefGoogle Scholar
  2. 2.
    Choudry HA, Pai RK, Shuai Y, Ramalingam L, Jones HL, Pingpank JF, Ahrendt SS, Holtzman MP, Zureikat AH, Zeh HJ, Bartlett DL (2018) Impact of cellularity on oncologic outcomes following cytoreductive surgery and hyperthermic intraperitoneal chemoperfusion for Pseudomyxoma Peritonei. Ann Surg Oncol 25(1):76–82.  https://doi.org/10.1245/s10434-017-6214-7 CrossRefGoogle Scholar
  3. 3.
    Yantiss RK, Shia J, Klimstra DS, Hahn HP, Odze RD, Misdraji J (2009) Prognostic significance of localized extra-appendiceal mucin deposition in appendiceal mucinous neoplasms. Am J Surg Pathol 33(2):248–255.  https://doi.org/10.1097/PAS.0b013e31817ec31e CrossRefGoogle Scholar
  4. 4.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213.  https://doi.org/10.1097/01.sla.0000133083.54934.ae CrossRefGoogle Scholar
  5. 5.
    Jacquet P, Sugarbaker PH (1996) Clinical research methodologies in diagnosis and staging of patients with peritoneal carcinomatosis. Cancer Treat Res 82:359–374.  https://doi.org/10.1007/978-1-4613-1247-5_23 CrossRefGoogle Scholar
  6. 6.
    Sugarbaker PH (2003) Peritonectomy procedures. Surg Oncol Clin N Am 12:703–727.  https://doi.org/10.1016/S1055-3207(03)00048-6 CrossRefGoogle Scholar
  7. 7.
    Sugarbaker PH (1995) Peritonectomy procedures. Ann Surg 221:29–42.  https://doi.org/10.1097/00000658-199501000-00004 CrossRefGoogle Scholar
  8. 8.
    Sugarbaker PH (1988) Surgical management of peritoneal carcinosis: diagnosis, prevention and treatment. Langenbecks Arch Chir 373:189–196.  https://doi.org/10.1007/BF01274232 CrossRefGoogle Scholar
  9. 9.
    Misdraji J, Yantiss RK, Graeme-Cook FM, Balis UJ, Young RH (2003) Appendiceal mucinous neoplasms: a clinicopathologic analysis of 107 cases. Am J Surg Pathol 27(8):1089–1103.  https://doi.org/10.1097/00000478-200308000-00006 CrossRefGoogle Scholar
  10. 10.
    Panarelli NC, Yantiss RK (2011) Mucinous neoplasms of the appendix and peritoneum. Arch Pathol Lab Med 135(10):1261–1268.  https://doi.org/10.5858/arpa.2011-0034-RA CrossRefGoogle Scholar
  11. 11.
    Pai RK, Longacre TA (2005) Appendiceal mucinous tumors and pseudomyxoma peritonei: histologic features, diagnostic problems, and proposed classification. Adv Anat Pathol 12(6):291–311.  https://doi.org/10.1097/01.pap.0000194625.05137.51 CrossRefGoogle Scholar
  12. 12.
    Young RH (2004) Pseudomyxoma peritonei and selected other aspects of the spread of appendiceal neoplasms. Semin Diagn Pathol 21(2):134–150.  https://doi.org/10.1053/j.semdp.2004.12.002 CrossRefGoogle Scholar
  13. 13.
    Carr NJ, Sobin LH (1996) Unusual tumors of the appendix and pseudomyxoma peritonei. Semin Diagn Pathol 13(4):314–325Google Scholar
  14. 14.
    Carr NJ, Finch J, Ilesley IC, Chandrakumaran K, Mohamed F, Mirnezami A, Cecil T, Moran B (2012) Pathology and prognosis in pseudomyxoma peritonei: a review of 274 cases. J Clin Pathol 65(10):919–923.  https://doi.org/10.1136/jclinpath-2012-200843 CrossRefGoogle Scholar
  15. 15.
    Bradley RF, Stewart JH 4th, Russell GB, Levine EA, Geisinger KR (2006) Pseudomyxoma peritonei of appendiceal origin: a clinicopathologic analysis of 101 patients uniformly treated at a single institution, with literature review. Am J Surg Pathol 30(5):551–559.  https://doi.org/10.1097/01.pas.0000202039.74837.7d CrossRefGoogle Scholar
  16. 16.
    Chua TC, Moran BJ, Sugarbaker PH, Levine EA, Glehen O, Gilly FN, Baratti D, Deraco M, Elias D, Sardi A, Liauw W, Yan TD, Barrios P, Gómez Portilla A, de Hingh IH, Ceelen WP, Pelz JO, Piso P, González-Moreno S, Van Der Speeten K, Morris DL (2012) Early- and long-term outcome data of patients with pseudomyxoma peritonei from appendiceal origin treated by a strategy of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. J Clin Oncol 30(20):2449–2456.  https://doi.org/10.1200/JCO.2011.39.7166 CrossRefGoogle Scholar
  17. 17.
    Higa E, Rosai J, Pizzimbono CA, Wise L (1973) Mucosal hyperplasia, mucinous cystadenoma, and mucinous cystadenocarcinoma of the appendix. A re-evaluation of appendiceal “mucocele”. Cancer 32(6):1525–1541CrossRefGoogle Scholar
  18. 18.
    Honoré C, Caruso F, Dartigues P, Benhaim L, Chirica M, Goéré D, Elias D (2015) Strategies for preventing Pseudomyxoma Peritonei after resection of a mucinous neoplasm of the appendix. Anticancer Res 35(9):4943–4947Google Scholar
  19. 19.
    Dromain C, Leboulleux S, Auperin A, Goere D, Malka D, Lumbroso J, Schumberger M, Sigal R, Elias D (2008) Staging of peritoneal carcinomatosis: enhanced CT vs. PET/CT. Abdom Imaging 33(1):87–93.  https://doi.org/10.1007/s00261-007-9211-7 CrossRefGoogle Scholar
  20. 20.
    Bozkurt M, Doganay S, Kantarci M, Yalcin A, Eren S, Atamanalp SS, Yuce I, Yildirgan MI (2011) Comparison of peritoneal tumor imaging using conventional MR imaging and diffusion-weighted MR imaging with different b values. Eur J Radiol 80(2):224–228.  https://doi.org/10.1016/j.ejrad.2010.06.004 CrossRefGoogle Scholar

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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