The present study compared the efficacy of two surgical techniques to treat pseudomyxoma peritonei (PMP): debulking and cytoreduction. Cytoreductive surgery achieved better surgical results and yielded higher 3- and 5-year survival rates, compared with debulking.

PMP is a rare condition caused by the production of abundant mucus by tumor cells, which fills the abdominal cavity. Almost all cases of PMP originate from primary tumors of the appendix. PMP is often treated surgically. Debulking is a surgical procedure aimed to remove as much of a tumor as possible, when a tumor cannot be completely excised. Cytoreductive surgery is similar to debulking, but more extensive, including the peritoneum – a membrane that covers the abdominal cavity. The extent of resection is expressed numerically, where R1 refers to the highest surgical efficacy, achieving removal of all visible disease, leaving only microscopic cancerous cells. To completely eradicate the cancer, surgery should be followed by chemotherapy given directly into the peritoneum (sequential intra-peritoneal chemotherapy; SPIC), sometimes as a warm solution (hyperthermic intraperitoneal chemotherapy; HIPEC).

This study included 150 patients who were followed-up for 15 years. 40 patients had debulking whereas 110 patients undergone cytoreduction; both procedures were followed by SPIC or HIPEC.

R1 resection was achieved in 25% of the patients who had debulking and 72% of those who undergone cytoreduction. SPIC was given to 27% of all patients but half of them could not complete the treatment due to the progressive disease, abdominal infection or the spreading of the tumor. The other 73% of the patients received HIPEC.

Side effects were more common in the cytoreduction group (47% versus 29%), but difference did not reach statistical significance. Surgical complications such as bleeding and perforation (tearing of abdominal organs) occurred in 16% of all patients, without substantial difference between the two groups.

The overall survival was 79% at three years and 62% at five years. The cytoreduction group had a higher 3- and 5-year survival rates compared to the debulking group (85%, 74% versus 65%, 40%).

In summary, this study demonstrated the higher surgical efficacy of cytoreduction compared to debulking for eradication of PMP. Extent of surgical resection correlated with better survival rates at 3 and 5 years post-surgery. Thus, cytoreduction should be considered as the first treatment choice in patients with PMP.

The main limitation of the study was the difference in patient characteristics between the two groups, which is understandable given the rarity of PMP.

Talk to your doctor about your surgical options for the treatment of pseudomyxoma peritonei (PMP) to see if cytoreduction is appropriate for you.