{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T23:53:54Z","timestamp":1793404434066,"version":"4.5.0"},"reference-count":16,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,8,26]],"date-time":"2021-08-26T00:00:00Z","timestamp":1629936000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> Pseudomyxoma peritonei (PMP) originating from appendiceal mucinous neoplasm is a rare peritoneal malignancy characterized by the progressive intraperitoneal accumulation of mucus leading to death if left untreated. In recent years, cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) offered increased survival rates. This study aims to identify the clinical, pathological, and surgical features influencing safety and survival outcomes of patients undergoing CRS and HIPEC for PMP of appendiceal origin.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> A retrospective analysis of all patients undergoing CRS and HIPEC for PMP of appendiceal origin from January 2015 to May 2019 was conducted at our institution.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> Study population included 50 patients (74% female, 26% male). The median age at CRS was 60 (38\u201384). The median peritoneal cancer index (PCI) was 17. Complete cytoreductive surgery (CC 0\u20131) was achieved in 47 patients (94%). HIPEC chemotherapeutic regimen was based on oxaliplatin for 13 (28%) patients and mitomycin for 34 (72%) patients. We experienced a total of 19 (38%) postoperative complications, of which 14 (74%) of grade I-II and 5 (26%) of grade III-IV, according to the Clavien-Dindo classification. The median follow-up period was 27 months (12\u2013107) from the date of cytoreductive surgery. The mean survival rate was 100 months, with a 5-year OS of 91%. The mean progression-free survival rate was 77 months (0\u2013107), with a 5-year PFS of 63%. Multivariate analysis identified adenocarcinoma histotype and incomplete cytoreduction to significantly worsen progression-free survival, while incomplete cytoreduction was the only independent predictor of poorer overall survival.<\/jats:p><jats:p><jats:bold>Conclusion:<\/jats:bold> Complete cytoreduction and appendiceal neoplasm histotype play a crucial role in the survival of patients affected by PMP of appendiceal origin. The rates of morbidity associated with CRS and HIPEC for PMP are acceptable.<\/jats:p>","DOI":"10.3389\/fsurg.2021.715119","type":"journal-article","created":{"date-parts":[[2021,8,27]],"date-time":"2021-08-27T21:41:00Z","timestamp":1630100460000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":21,"title":["Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy for Pseudomyxoma Peritonei of Appendiceal Origin: A Single Center Experience"],"prefix":"10.3389","volume":"8","author":[{"given":"Francesco","family":"Santullo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Pacelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo","family":"Abatini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miriam","family":"Attalla El Halabieh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giusy","family":"Fortunato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudio","family":"Lodoli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Giovinazzo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Rotolo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Di Giorgio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,8,26]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"526","DOI":"10.1245\/s10434-007-9691-2","article-title":"Pseudomyxoma peritonei: clinical pathological and biological prognostic factors in patients treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC)","volume":"15","author":"Baratti","year":"2008","journal-title":"Ann Surg Onc."},{"key":"B2","doi-asserted-by":"publisher","first-page":"919","DOI":"10.1136\/jclinpath-2012-200843","article-title":"Pathology and prognosis in pseudomyxoma peritonei: a review of 274 cases","volume":"65","author":"Carr","year":"2012","journal-title":"J Clin Path."},{"key":"B3","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1097\/PAS.0000000000000535","article-title":"A consensus for classification and pathologic reporting of pseudomyxoma peritonei and associated appendiceal neoplasia","volume":"40","author":"Carr","year":"2016","journal-title":"Am J Surg Pathol."},{"key":"B4","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1016\/j.ejso.2020.02.012","article-title":"Appendiceal tumours and pseudomyxoma peritonei: literature review with PSOGI\/EURACAN clinical practice guidelines for diagnosis and treatment","volume":"47","author":"Govaerts","year":"2020","journal-title":"Eur J Surg Oncol."},{"key":"B5","doi-asserted-by":"publisher","first-page":"2449","DOI":"10.1200\/jco.2012.30.4_suppl.532","article-title":"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","volume":"30","author":"Chua","year":"2012","journal-title":"J Clin Oncol."},{"key":"B6","doi-asserted-by":"publisher","first-page":"703","DOI":"10.1016\/S1055-3207(03)00048-6","article-title":"Peritonectomy procedures","volume":"12","author":"Sugarbaker","year":"2003","journal-title":"Surg Oncol Clin."},{"key":"B7","doi-asserted-by":"publisher","first-page":"555","DOI":"10.1007\/s13304-018-0578-5","article-title":"Hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal malignancies using new hybrid CO2 system: preliminary experience in referral center","volume":"71","author":"Cianci","year":"2019","journal-title":"Updates Surg."},{"key":"B8","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1007\/s13304-018-0557-x","article-title":"A novel HIPEC technique using hybrid CO2 recirculation system: intra-abdominal diffusion test in a porcine model","volume":"70","author":"Cianci","year":"2018","journal-title":"Updates Surg."},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1007\/s13304-021-01034-2","article-title":"Cytoreductive surgery and mitomycin C hyperthermic intraperitoneal chemotherapy with CO2 recirculation (HIPEC-CO2) for colorectal cancer peritoneal metastases: analysis of short-term outcomes","author":"Rotolo","year":"","journal-title":"Updates Surg. (2"},{"key":"B10","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1097\/SLA.0b013e3181b13ca2","article-title":"The clavien-dindo classification of surgical complications: five-year experience","volume":"250","author":"Clavien","year":"2009","journal-title":"Ann Surg."},{"key":"B11","doi-asserted-by":"publisher","first-page":"404","DOI":"10.1245\/s10434-017-6252-1","article-title":"Validation of the recent psogi pathological classification of pseudomyxoma peritonei in a single-center series of 265 patients treated by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy","volume":"25","author":"Baratti","year":"2018","journal-title":"Ann Surg Oncol."},{"key":"B12","doi-asserted-by":"publisher","first-page":"1035","DOI":"10.1016\/j.ejso.2016.03.017","article-title":"Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in 1000 patients with perforated appendiceal epithelial tumours","volume":"42","author":"Ansari","year":"2016","journal-title":"Eur J Surg Oncol."},{"key":"B13","doi-asserted-by":"publisher","first-page":"1164","DOI":"10.1002\/bjs.6235","article-title":"Peritoneal pseudomyxoma: results of a systematic policy of complete cytoreductive surgery and hyperthermic intraperitoneal chemotherapy","volume":"95","author":"Elias","year":"2008","journal-title":"Br J Surg."},{"key":"B14","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s13304-020-00788-5","article-title":"Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in pseudomyxoma peritonei of appendiceal origin: result of a single centre study","volume":"14","author":"Di Leo","year":"2020","journal-title":"Updates Surg."},{"key":"B15","doi-asserted-by":"publisher","first-page":"899","DOI":"10.1007\/s11605-019-04239-4","article-title":"Outcomes following cytoreduction and HIPEC for pseudomyxoma peritonei: 10-year experience","volume":"24","author":"Narasimhan","year":"2020","journal-title":"J Gastrointest Surg."},{"key":"B16","doi-asserted-by":"publisher","first-page":"e206363","DOI":"10.1001\/jamasurg.2020.6363","article-title":"The role of hyperthermic intraperitoneal chemotherapy in pseudomyxoma peritonei after cytoreductive surgery","volume":"156","author":"Kusamura","year":"2021","journal-title":"JAMA Surg."}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2021.715119\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,8,27]],"date-time":"2021-08-27T21:41:02Z","timestamp":1630100462000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2021.715119\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,26]]},"references-count":16,"alternative-id":["10.3389\/fsurg.2021.715119"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2021.715119","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8,26]]},"article-number":"715119"}}