Ekstensiv peritonektomi. Ny behandling af pseudomyxoma peritonei
Sammanfattning
Introduction: Pseudomyxoma peritonei is a rare condition characterized by the production of copious amounts of mucus within the peritoneal cavity as a result of neoplastic mucus-secreting cells proliferating on the peritoneal surfaces. Untreated, these patients eventually die from intestinal obstruction. In other countries, the approach to pseudomyxoma peritonei is based on cytoreductive surgery consisting of peritonectomy followed by locoregional chemotherapy. This paper describes the first 14 patients referred to Århus Hospital for cytoreductive surgery. Materials and methods: Preoperatively, all patients were evaluated by gastroscopy, colonoscopy, and abdominal CT scan in order to exclude another malignancy and to determine the extent of the pseudomyxoma. The surgical procudure was carried out by excision of the parietal peritoneum and resection of dispensable organs if their visceral peritoneal surfaces were involved. On vital organs, all tumour deposits > 2 mm were excised. Postoperatively, 5-fluorouracil and leucovorin were instilled into the abdomen. Follow-up was carried out by abdominal CT scan once in a year. Results: Three patients had another disease diagnosed preoperatively. Cytoreductive surgery was performed with curative intent in ten patients. Besides excision of the parietal peritoneum, colectomy was indicated in nine patients. Few and only minor complications were observed postoperatively. To date, no recurrences have been detected. Discussion: Peritonectomy followed by locoregional chemotherapy seems to be an effective treatment approach to pseudomoxyma peritonei. Despite the aggressive treatment modality, no serious complications were observed in the study.