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CYTOREDUCTIVE SURGERY PLUS HYPERTHERMIC INTRAPERITONIAL CHEMOTHERAPY IN TREATMENT OF APPENDICEAL MUCINOUS NEOPLASIA WITH PSEUDOMYXOMA. CASE REPORT
Apresentação do caso
Patient, 52 years old, female; operated in the city of origin for acute appendicitis. Pathology of low-grade mucinous neoplasm of the appendix. Normal chest tomography. Abdominal tomography with multiple peritoneal lesions predominant in the larger omentum; bilateral complex cystic lesions, ovarian and parietal thickening of the rectum 11 cm from the anal zone. CEA: 7.9; CA 19-9: 79.2; CA 125: 195. Physical examination: ECOG 0, globose abdomen, rectal examination up to 7 cm without any changes. It was performed Cytoreductive surgery (CRS) plus hyperthermic intraperitoneal QT (HIPEC). Surgery performed on September 13, 2018, starting at 8 am and ending at 5 pm (02 IU plasma and 02 IU red blood cells).
Cavity inventory: Peritoneal carcinomatosis index of 21.
Complete CRS: Bilateral diaphragmatic peritoniectomy, right colectomy, rectosigmoidectomy, splenectomy, cholecystectomy, hysterectomy, bilateral adnexectomy and omentectomys, colorectal anastomosis before the perfusion phase, and protective ileocolostomy after.
Oxaliplatin 300 mg/m2 IP, heated 42º, 1 hour, closed technique, with 5-FU 400 mg/m2 IV and folinic acid 20 mg/m2 IV. Admitted to the intensive care unit for 72 hours, envolved with pneumonia and pleural effusion, being treated with pleural drainage and antibiotics and being discharged on the 18th postoperative. Histological work-up revealed R0 resection.
Pseudomyxoma peritonei, low-grade appendix mucinous neoplasm (LAMN).
Closing of ileocolostomy on February 21, 2019. She didn’t undergo adjuvant treatment and has been on oncological follow-up with no evidence of recurrence for 3 years.
Citoreductive surgery plus HIPEC is important in local disease control and symptom relief, with overall survival reaching 58% in 5 years and 18% in 10 years. Moreover, 68% of patients with PMP die from complications of the extension of the local disease, showing the importance of debulking even with distant metastasis.
The PCI is an important prognostic predictor, several centers use 20 as a limit for CRS, but more important than tumor burden volume is the extent of peritoneal disease in the abdomen, as the patient choice as well. Other limiting factors for CRS plus HIPEC are extra-abdominal disease and large retroperitoneal tumors
The combination of CRS plus HIPEC is the standard treatment for appendix mucinous neoplasms with pseudomyxoma, being considered curative treatment for selected patients and showing benefits in quality of life and overall survival as well.
Cytoreductive surgery; HIPEC; peritoneal carcinomatosis
Cirurgia Citorredutora / HIPEC*
MAURICIO PEREIRA SILVA FILHO, FLAVIA FERREIRA MAGALINI, JUNEA CARIS OLIVEIRA, EDUARDO MARCUCCI PRACUCHO, KARLA THAIZA THOMAL, EDERSON ROBERTO MATTOS, CELSO ROBERTO PASSERI, VITOR AUGUSTO MELAO, BEATRIZ MARTINHAO HIGA, RENATO MORATO ZANATTO