Total parietal peritonectomy and multivisceral resection for extensive cytoreductive surgery in pseudomyxoma peritonei: En bloc "Rolled-up carpet" technique and perioperative and oncologic outcomes

Xin Tang; Wenjuan Li; Xueyang Zhang; Jiaqi Ren; Ziyan He; Hongming Li; Xiaojiang Yi; Xinquan Lu; Xiaochuang Feng; Weilin Liao; Jiaxin Lin; Jiahao Wang; Dechang Diao

doi:10.1016/j.ejso.2024.109496

Total parietal peritonectomy and multivisceral resection for extensive cytoreductive surgery in pseudomyxoma peritonei: En bloc "Rolled-up carpet" technique and perioperative and oncologic outcomes

Eur J Surg Oncol. 2024 Nov 24;51(2):109496. doi: 10.1016/j.ejso.2024.109496. Online ahead of print.

Authors

Affiliations

¹ The Second Clinical Medical School of Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China.
² Department of Gastrointestinal Surgery, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, China.
³ Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China. Electronic address: diaodechang@163.com.

PMID: 39616775
DOI: 10.1016/j.ejso.2024.109496

Abstract

Background: Patients diagnosed with pseudomyxoma peritonei (PMP) of appendiceal origin typically present with high tumor burden and require extensive cytoreductive surgery (CRS) to achieve optimal cytoreduction. This study describes an en bloc "rolled-up carpet" surgical technique for total parietal peritonectomy and multivisceral resection while also analyzing the perioperative and tumor outcomes of this technique.

Methods: The study reviewed the data of 7 patients underwent en bloc "rolled-up carpet" extensive CRS between August 2020 and April 2023. Perioperative and tumor outcomes were analyzed.

Results: Seven patients underwent extensive treatment involving total peritoneal and multivisceral resection. Complete cytoreduction was successfully achieved in all patients. Six patients (85.7 %) successfully completed hyperthermic intraperitoneal chemotherapy (HIPEC). Three patients (42.9 %) had low-grade mucinous appendiceal neoplasm, while the remaining four patients (57.1 %) had high-grade. Two patients (28.6 %) experienced major morbidity, which was successfully treated, and they were discharged. There were no secondary surgery and no surgery-related mortality. During a median follow-up of 25 months (range, 12-46 months), no patient experienced recurrence. After 12 months postoperatively, the quality of life (QOL) of the 7 patients was assessed using the EORTC QLQ-C30, revealing scores similar to the reference values of the EORTC general population (p > 0.05).

Conclusion: En bloc "rolled-up carpet" extensive cytoreductive surgery is a feasible and safe technique for the treatment of appendiceal PMP with high tumor burden. This technique achieved complete cytoreduction with acceptable blood loss volume, operative time, and major morbidity. In short-term follow-up, no recurrence was noted, with patients having a satisfactory QOL.

Keywords: Appendiceal mucinous neoplasm; Cytoreductive surgery; En bloc resection; Multivisceral resection; Pseudomyxoma peritonei; Total parietal peritonectomy.