Peritoneal carcinomatosis treated with cytoreductive surgery and intraperitoneal chemotherapy / Carcinomatose peritoneal tratada com cirurgia citoreductiva e quimioterapia intraperitoneal

ABSTRACT Introduction: To evaluate the combined treatment with cytoreductive surgery and intraperitoneal chemotherapy for peritoneal carcinomatosis arising from colorectal cancer, pseudomyxoma peritonei and mesothelioma. Methods: Data were obtained from 73 patients with peritoneal carcinomatosis arising from colorectal cancer (52.1%), pseudomyxoma peritonei (41.1%) or mesothelioma (6.8%) between 2002 and 2011. We reported the morbidity grade (II, III and IV), mortality and survival rates of the candidates after cytoreductive surgery and intraperitoneal chemotherapy. Results: 41 (56.2%) women participated, and the median age was 50 years. Thirty-nine patients (53.4%) underwent complete cytoreductive surgery and intraperitoneal chemotherapy. Patients who underwent a complete cytoreduction received intraperitoneal chemotherapy with mitomycin C, from which only 16/39 (41%) had hyperthermic intraperitoneal chemotherapy (41-42 °C). The overall morbidity rate was 23.3% and the grade III/IV complication rate was 12.3%. The overall mortality rate was 5.5%. The univariate analysis showed that cytoreductive surgery and intraperitoneal chemotherapy (p = .029), a blood transfusion (p = .002) and the operative time (p = .001) were significant for the occurrence of postoperative complications. Patients with peritoneal carcinomatosis from colorectal cancer who underwent complete cytoreductive surgery and intraperitoneal chemotherapy had overall survival rates of 81.3%, 12.5% and 12.5% at 1, 3 and 5 years, respectively. Patients with peritoneal carcinomatosis from pseudomyxoma peritonei who underwent complete cytoreductive surgery and intraperitoneal chemotherapy had overall survival rates of 84.2%, 77.7% and 77.7% at 1, 3 and 5 years, respectively. Conclusion: The combined treatment for peritoneal carcinomatosis may be performed safely with acceptable morbidity and mortality in a specialized unit setting. Although over half of patients underwent normothermic intraperitoneal chemotherapy, our results were comparable to results from others centers.

RESUMO Introdução: O objetivo foi avaliar o tratamento combinado da cirurgia citorredutora e quimioterapia intraperitoneal em pacientes com carcinomatose peritoneal secundária ao câncer colorretal, pseudomixoma peritoneal e mesotelioma. Métodos: Foram obtidos dados de 73 pacientes com carcinomatose peritoneal secundária ao cirurgia citorredutora (52.1%), pseudomixoma peritoneal (41,1%) ou mesotelioma (6,8%). Foram avaliados o grau de morbidade, a taxa de mortalidade e as taxas de sobrevida após a cirurgia citorredutora e quimioterapia intraperitoneal. Resultados: 41 (56,2%) pacientes do sexo feminino participaram, com média de idade de 50 anos. 39 pacientes (53,4%) foram submetidos a cirurgia citorredutora completa e quimioterapia intraperitoneal. Todos esses receberam Mitomicina C, sendo 16/39 (41%) quimioterapia intraperitoneal hipertérmica (41-42°C). A morbidade global foi 23,3%, com taxa de mortalidade global de 5,5%. A análise univariada mostrou que câncer colorretal e quimioterapia intraperitoneal (p = .029), transfusão sanguínea (p = .002) e tempo operatório (p = .001) foram associados com complicações pós-operatórias. Pacientes com carcinomatose peritoneal secundária ao cirurgia citorredutora submetidos a cirurgia citorredutora completa e quimioterapia intraperitoneal tiveram sobrevida global de 81,3%; 12,5% e 12,5% em 1, 3 e 5 anos, respectivamente. Os pacientes com pseudomixoma peritoneal que foram submetidos a cirurgia citorredutora completa e quimioterapia intraperitoneal tiveram sobrevida global de 84,2%; 77,7% e 77.7% em 1, 3 e 5 anos, respectivamente. Conclusão: O tratamento combinado para carcinomatose peritoneal é seguro quando realizado em centros terciários com experiência no procedimento. Embora mais da metade dos pacientes tenham sido submetidos a quimioterapia intraperitoneal normotérmica após a cirurgia citorredutora completa, os resultados podem ser comparados a de outros centros que utilizam exclusivamente a quimioterapia hipertérmica.

Pseudomyxoma peritonei originating from appendix tumors / Pseudomixoma peritoneal com origem em tumores do apêndice

ABSTRACT Background: Appendix tumors represent about 1% of all gastrointestinal neoplasia, in other words they are quite rare. However, there is a specific type of appendiceal neoplasms (mucinous adenocarcinoma) that spreads to the peritoneum and in almost 20% of the cases, resulting in a disease called pseudomyxoma peritonei. Although, it is a very rare condition, it is nonetheless a very severe one and therefore it is crucial to know how to correctly diagnose and treat it. Objective: This study provides updated data on how to diagnose, classify and treat pseudomyxoma peritonei that originates from appendix tumors. Methods: A bibliographic research was performed on PubMed database, including articles published since 2000, as well as, cross-referencing with the initial research. Discussion: In the past, patients diagnosed with pseudomyxoma peritonei would only undergo palliative measures, so their overall survival rate was greatly reduced. Over the years pseudomyxoma peritonei treatment has evolved and patients are now undergoing treatment which is a combination of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. This new therapy has allowed an increase of survival chances of up to 5 years in those patients with values between 53% and 88%, depending on the type of tumor. Conclusion: Despite the great progress we have witnessed in recent years, which have led to a large increase in survival rates, more research needs to be done, on what to do when the disease is in an unresectable stage. Finding a less aggressive therapy than cytoreductive surgery + hyperthermic intraperitoneal chemotherapy will be an important step forward.

RESUMO Introdução: As neoplasias do apêndice são bastante raras, representando atualmente cerca de 1% de todas as neoplasias gastrointestinais. O adenocarcinoma mucinoso é um dos subtipos de neoplasia do apêndice e caracteriza-se por metastizar para o peritoneu, em 20% dos casos, facto que se manifesta sob a forma de uma doença designada por Pseudomixoma Peritoneal. Apesar de ser uma condição muito rara, a sua extrema gravidade justifica a importância de a saber diagnosticar e tratar corretamente. Métodos: Foi realizada uma pesquisa bibliográfica na base de dados PubMed, incluindo artigos publicados desde 2000 bem como artigos de pesquisa cruzada com os iniciais. Discussão: No passado, os doentes diagnosticados com Pseudomixoma Peritoneal eram apenas submetidos a medidas paliativas, pelo que a sua sobrevida era muito reduzida. Ao longo dos anos o tratamento do Pseudomixoma Peritoneal foi evoluindo sendo agora os doentes submetidos a uma combinação de cirurgia citoredutiva e quimioterapia hipertérmica intraperitoneal. Esta nova terapêutica tem permitido aumentar a sobrevida aos 5 anos destes pacientes para valores entre os 53% e os 88%, dependendo do tipo de tumor. Conclusões: Apesar dos grandes avanços que se têm verificado, e que culminaram com um grande aumento das taxas de sobrevivência, devem ser feitos mais estudos que encontrem novas abordagens para quando o tumor já é diagnosticado num estado irressecável, bem como terapêuticas menos invasivas.

Pseudomixoma peritoneal por tumor del apéndice cecal / Peritoneal pseudomyxoma due to cecal appendix tumor

Objetivo: presentar un caso de una patología de muy baja incidencia y realizar una revisión bibliográfica de la misma. Paciente y método: paciente femenina de 87 años de edad que ingresa por guardia por cuadro compatible con hernia inguinal atascada, por lo que se decide cirugía de urgencia. En el acto operatorio se identifica un saco herniario de paredes engrosadas, con contenido intestinal con buena vitalidad, sin signos de necrosis, identificando además abundante secreción mucinosa en el saco herniario y proveniente de la cavidad abdominal. Se decide terminar con la hernioplastia y realizar estudios complementarios diferidos. Luego de los mismos, el comité de tumores decide la realización de nueva cirugía (hemicolectomía derecha con ileotransverso anastomosis por tumor mucinoso de apéndice), durante la cual se constata ascitis gelatinosa. La paciente evoluciona favorablemente y es dada de alta a las 72 horas del post operatorio. La anatomía patológica informa adenocarcinoma mucinoso de apéndice bien diferenciado. Discusión: el Pseudomixoma Peritoneal es una entidad muy poco frecuente, que hace referencia a la diseminación peritoneal de un tumor cuyas células producen gran cantidad de mucina. La supervivencia global de los pacientes es de aproximadamente 75 y 68% durante 5 y 10 años. La clasificación más aceptada es la de Ronnet. Tradicionalmente, el tratamiento ha sido la cirugía de citoreducción, aunque hay autores que proponen procedimientos más agresivos como la peritonectomía más quimioterapia hipertérmica intraoperatoria.

Objective: to present a case of a very low incidence disease and a bibliographic review of it. Patient and method: 87 years old female patient with a compatible history and physical exam for a stuck inguinal hernia, for which we decided to perform emergency surgery. During the surgical procedure, we find a thickened hernia sac, with mucus in it and in the abdominal cavity. The small intestine was vital and not complicated. We finished the hernioplasty, and decided to perform complementary ambulatory studies to the patient. After having them done, we decided, in an interdisciplinary committee, to perform an exploratory surgery, (hemicolectomy with ileum transverse anastomosis for an appendix tumor), during which gelatinous ascites was noticed. The patient evolve favorably and was discharged 72 hours post operation. The surgical biopsy informed an appendix mucinous adenocarcinoma well differentiated. Discussion: the peritoneal pseudomyxoma is a very infrequent entity. The overall survival is 75 and 68% for 5 and 10 years, respectively. Ronnet had published the most accepted histological classification. The accepted treatment is the cytoreductive surgery, although some authors proposed a more aggressive treatment such peritonectomy with hyerthermic intraperitoneal chemotherapy.

Pseudomyxome peritoneal

Le pseudomyxome du peritoine est une affection dont la genese est peu connue. De plus sa rarete est confirmee par les 2 cas decouverts de maniere fortuite sur 10.000 laparotomies. Le tableau clinique est pauvre; fait de distension et douleurs abdominales. Il semble que le pseudomyxome soit consecutive a la rupture d'un muccocele appendiculaire. L'association soit a des tumeurs malignes bien differenciees soit a des tumeurs frontieres a souvent ete retrouvee. La production extracellulaire de mucine dans la cavite peritoneale constitue un critere majeur de diagnostic. Le traitement adequat associe la chirurgie complete des lesions macroscopiques et la chimiotherapie intraperitoneale en utilisant certaines molecules qui ont montre leur efficacite

Anestesia para peritonectomia com quimioterapia intraperitoneal hipertérmica transoperatória: relato de caso / Anesthesia for peritonectomy with hyperthermic intraoperative peritoneal chemotherapy: case report / Anestesia para peritonectomía con quimioterapia intraperitoneal hipertérmica transoperatória: relato de caso

JUSTIFICATIVA E OBJETIVOS: O pseudomixoma peritoneal é uma condição rara, relacionada com neoplasias epiteliais de apêndice e ovário. O tratamento de escolha é a citorredução cirúrgica, peritonectomia e quimioterapia intra-abdominal hipertérmica transoperatória (QIAHT). Cabe ao anestesiologista a manutenção de normovolemia, normotermia, manejo da dor pós-operatória e do estado de coagulação. O objetivo foi descrever um caso de peritonectomia com QIAHT. RELATO DO CASO: Paciente do sexo feminino, 37 anos, ASA I, apendicectomia há 3 meses, com laudo anatomopatológico de cistoadenoma mucinoso. Após revisão da peça, evidenciou-se pseudomixoma peritoneal, com indicação de peritonectomia com QIAHT. Instalou-se cateter peridural (T11-T12), dose-teste e morfina. Procedeu-se à indução anestésica com remifentanil 0,4 µg.kg-1.min-1, propofol e rocurônio, além de intubação orotraqueal em sequência rápida. A manutenção foi realizada com remifentanil, sevoflurano e rocurônio, conforme o TOF. Ropivacaína 50 mg e fentanil 100 µg em 10 mL foram administrados via cateter peridural 10 minutos antes da incisão. Durante toda a cirurgia, PVC, SpO2, FeCO2, temperatura, frequência cardíaca, PAM e diurese mantiveram-se em valores estáveis dentro da normalidade, inclusive no período da QIAHT. Redução no hematócrito e SvO2, alargamento do TAP e plaquetopenia foram corrigidos com a administração de hemocomponentes. Após 13 horas de cirurgia, a paciente foi admitida na UTI em ventilação controlada. Foi extubada no 1º dia de pós-operatório, recebendo alta hospitalar no 17º dia de internamento. CONCLUSÕES: A citorredução cirúrgica e a peritonectomia com QIAHT surgiram na década de 1990, com diversos estudos revelando aumento significativo da sobrevida. Pela complexidade do procedimento e grande porte cirúrgico, é fundamental a vigilância do anestesiologista para a manutenção dos parâmetros clínicos, laboratoriais, reconhecimento e tratamento de qualquer alteração.

BACKGROUND AND OBJECTIVES: Pseudomyxoma peritonei is a rare condition related to epithelial neoplasia of the appendix and ovaries. Surgical cytoreduction, peritonectomy, and hyperthermic intraoperative peritoneal chemotherapy (HIPEC) is the treatment of choice. Maintenance of normovolemia, normothermia, postoperative pain management and coagulation status are all responsibility of the anesthesiologist. The objective of this report was to describe a case of peritonectomy with HIPEC. CASE REPORT: This is a 37 year-old female, ASA I, with a history of appendectomy 3 months ago with an anatomopathological report of mucinous cystoadenoma. After review of the pathological sample, a pseudomyxoma peritonei was diagnosed with indication of peritonectomy with HIPEC. An epidural catheter (T11-T12) was placed and a test-dose, as well as morphine, was administered. Anesthesia was induced with remifentanil, 0.4 µg.kg-1.min-1, propofol, and rocuronium, besides rapid-sequence orotracheal intubation. Remifentanil, sevoflurane, and rocuronium were used for anesthesia maintenance according to the TOF. Ropivacaine 50 mg, and fentanyl 10 µg. in 10 mL were administered through the epidural catheter 10 minutes before incision. During the surgery, CVP, SpO2, FeCO2, temperature, heart rate, MAP, and urine output maintained stable levels within normal limits, including during HIPEC. Reduction of the hematocrit and SvO2, increased PT, and thrombocytopenia were corrected by administering blood products. After 13 hours of surgery, the patient was admitted to the ICU under controlled ventilation. She was extubated on the 1st postoperative day, being discharged from the hospital on the 17th day of hospitalization. CONCLUSIONS: Surgical cytoreduction and peritonectomy with HIPEC goes back to the decade of 1990 with several studies showing a significant increase in survival. Due to the complexity of the procedure and large surgery the vigilance of the anesthesiologist ...

JUSTIFICATIVA Y OBJETIVOS: El seudomixoma peritoneal es una condición rara, relacionada con neoplasias epiteliales de apéndice y ovario. El tratamiento de elección es la citorreducción quirúrgica, peritonectomía y quimioterapia intraabdominal hipertérmica transoperatoria (QIAHT). Le concierne al anestesiólogo mantener la normovolemia, normotermia, el manejo del dolor postoperatorio y el estado de coagulación. El objetivo de este estudio fue describir un caso de peritonectomía con QIAHT. RELATO DEL CASO: Paciente femenina, 37 años, ASA I, con apendicectomía hace 3 meses, con laudo anatomopatológico de cistoadenoma mucinoso. Después de revisada la pieza, quedó evidenciado el seudomixoma peritoneal, con una indicación de peritonectomía con QIAHT. Se instaló un catéter epidural (T11-T12), dosis de test y morfina. Se procedió entonces a la inducción anestésica con remifentanil 0,4 µg.kg-1.min-1, propofol y rocuronio, además de intubación orotraqueal en secuencia rápida. El mantenimiento se hizo con remifentanil, sevoflurano y rocuronio, conforme al TOF. Fueron administrados vía catéter epidural 10 minutos antes de la incisión ropivacaína 50 mg y fentanil 100 µg en 10 mL. Durante toda la cirugía, PVC, SpO2, FeCO2, la temperatura, frecuencia cardíaca, PAM y diuresis mantuvieron valores estables dentro de la normalidad, inclusive en el período de la QIAHT. Reducción en el hematocrito y SvO2, el ensanchamiento del TAP y la plaquetopenia fueron corregidos con la administración de hemocomponentes. Después de 13 horas de cirugía, la paciente fue admitida en la UCI en ventilación controlada. Se extubó el 1º día del postoperatorio, con alta al 17º día del ingreso. CONCLUSIONES: La citorreducción quirúrgica y la peritonectomía con QIAHT surgieron en la década de 1990, con diversos estudios revelando el aumento significativo de la sobrevida. En función de la complejidad del procedimiento y de la gran demanda quirúrgica, es fundamental que el anestesista ...

Peritoneal pseudomyxoma associated with synchronic malignant mucinous neoplasias of the cecum, appendix and rectum: case report and review of the literature

Peritoneal pseudomyxoma is a pathological condition that compromises the peritoneum, characterized by the production of large quantities of mucinous liquid, which progressively fills the peritoneal cavity, originating in general from mucinous appendicular or ovarian tumors. We report a peritonial pseudomyxoma associated with mucinous adenocarcinoma of the appendix synchronic with adenocarcinoma of the rectum in 44 years old patient, where the initial diagnosis was rectal adenocarcinoma. Tumour of the appendix and peritonial pseudomyxoma were incidental and found intraoperativelly. We focus the histological patterns of the lesions, diagnosis and the treatment, with revision of the literature.

O pseudomixoma peritoneal é uma condição patológica que acomete o peritoneo, caracterizada pela produção de grandes quantidades de líquido mucinoso, que progressivamente preenche a cavidade peritoneal, tendo em geral como origem tumores mucinosos apendiculares ou de ovário. Relatamos a ocorrência de um pseudomixoma peritoneal associado a adenocarcinoma mucinoso do apêndice sincrônico e adenocarcinoma do reto em paciente de 44 anos, cujo diagnóstico inicial foi de adenocarcinoma do reto. A neoplasia do apêndice e o pseudomixoma peritonial foram achados incidentais, intra-operatórios. Enfocamos as principais características anatomo-patológicas das lesões, o diagnóstico e tratamento, através de ampla revisão da literatura.

Pseudomyxoma peritonei: a review of 17 cases

To evaluate the various presentations, causes and management of Pseudomyxoma Peritonei [PMP], and to create awareness among young surgeons regarding its importance. Retrospective study from Jan. 1999 to Dec. 2005. Surgical Unit of Khyber Teaching Hospital, Peshawar and Gynaecology and Obstetrics Unit, Hayatabad Medical Complex, Peshawar. All patients who had Pseudomyxoma Peritonei during the study period. The clinical records of all patients undergoing laparotomy for various causes were reviewed and cases of PMP separated. Their biodata, clinical presentation, clinical diagnosis, investigation results, operative findings, histopathology report and outcome were recorded. Out of 23,573 cases that underwent laparotomy 17 cases of PMP were on record. All were diagnosed incidentally per-operatively. Most [47.05%] cases were seen in the age group of 30-40 years and 58.82% patients were females. Abdominal pain, mass, abdominal distension and intestinal obstruction were the common presenting features. Ultrasound and CT scan reported three cases as ovarian cysts, three as multiple encysted fluid collections with thin cyst walls, two as ascites, two as ascites with peritoneal thickening, but none as PMP. Surgery was the mainstay of treatment. Appendicectomy with clearing of mucin in 11[64.70%], oophorechtomy and appendicectomy in 3[17.64%], bilateral oophorechtomy and hysterectomy in 2[11.76%], right hemi-colectomy in 1[5.88%] and second look surgery for complications were done in 2[11.76%] cases. Mortality was 11.76% and due to complication including one due to intestinal obstruction and another due to septicemia following second look surgery. Histopathological tissue diagnosis was available in only 13 cases and included mucinous adenoma appendix in five, mucinous cystadenoma ovary in three, mucinous epithelial cells of unknown origin in four and mucinous cystadenoma of borderline malignancy in one case. PMP is under reported in our setup. Pre-operative diagnosis is difficult and incidental findings usually go unnoticed due to lack of awareness and standard management protocol. There is a need to create awareness among surgeons, radiologists, pathologist and oncologist regarding this condition for the better outcome

Pseudomixoma peritoneal: diagnóstico y tratamiento / Pseudomyxoma peritonei: diagnosis and treatment

Introducción: el pseudomixoma peritoneal (PMP) es una entidad clínica poco frecuente, caracterizada por múltiples implantes peritoneales, de un material mucinoso derivado generalmente de un tumor mucosecretor, que se localiza con mayor frecuencia en apéndice, ovario y páncreas. En un 10 de los casos no se puede determinar su origen.Caso Clínico: Varón, de 69 años, que consulta por distensión abdominal progresiva y pérdida de peso (16 Kg.) de un año de evolución exacerbada en los últimos 3 meses asociada a dolor abdominal difuso y estado nauseoso. Se realiza una laparotomía exploradora mediana supra-infraumbilical, la cual permitió drenar abundante cantidad de contenido mucinoso, constatándose el compromiso de varios órganos, especialmente el ciego. Ante la imposibilidad de llevar a cabo el procedimiento de Sugarbaker, por el grado de compromiso de las estructuras abdominales, se prcedió a instilar Mitomicina C (12,5/m2 de superficie corporal) intraoperatoria, hipertérmica (43º C) durante 90 minutos. El paciente evoluciona favorablemente, retirándose los drenajes, gracias al descenso gradual del débito.Discusión: Representa el primer caso en 95 años de labor asistencial en nuestra institución. Como factores que empeoran el pronóstico, se han descrito, la presencia de distensión abdominal, sexo masculino, historia de pérdida de peso, enfermedad difusa, afectación de órganos vecinos (todos presentes en nuestro paciente). La incidencia de esta patología es baja, según lo reportado por la literatura, no obstante esta es más frecuente en mujeres. Creemos que la cirugía es de suma utilidad, teniendo en cuenta que permite obtener un diagnóstico, la posibilidad de drenar el contenido mucinoso de la cavidad, y en los mejores casos realizar los procedimientos de Sugarbaker, Siendo paliativo el tratamiento realizado por nuestro equipo, el paciente experimentó una mejoría clínica importante, lo cual le permitió su reinserción familiar y laboral.

[Pseudomyxoma peritoneal, about two cases and review of the literature]

In this article, we present two cases of peritoneal pseudomyxoma suspected on abdominal CT Scan and then confirmed on pathologic examination. A mucinus carcinoma was the primary lesion in the two cases, appendicular in the first case and with an undeterminate origin in the second. The prognosis was bad in these cases despite the debulking surgery and the systemic and intraperitoneal chemotherapy

Pseudomixoma peritoneal associado a lúpus eritematoso sistêmico: reporte de caso / Pseudomyxoma peritonei in association with systemic lupus erythematosus: case report

Descreve-se o caso de uma paciente jovem com ascite, dor abdominal, emagrecimento e poliartralgias. Foi feito diagnóstico de pseudomixoma peritoneal de ovário. Lúpus eritematoso sistêmico foi diagnosticado como patologia associada. Os autores apresentam breve revisao da literatura.

Pseudomixoma peritoneal secundario a cistoadenocarcinoma del apéndice cecal: caso clínico / Pseudomyxome peritonei secondary to a cystadenocarcinoma of the appendix: clinical case

We report a 40 years old female that presented with an ovarian tumor and ascitis. The exploratory laparotomy revealed a mucocele of the appendix that was informed as a cystadenoma of the appendix in the fast biopsy. The definitive pathological diagnosis, a cystadenocarcinoma of the appendix, motivated a second intervention, preforming a right hemicolectomy, left adnexectomy and omentumectomy. Three years later she presented with an abdominal mass and was subjected to a total hysterectomy and right adnexectomy. The pathological diagnosis was a mucinous cystadenocarcinoma with peritoneal involvement. The patient completed five years of follow up since the first intervention and is free of tumor. Pseudomixome peritoneai generally is a tumor of ovarian origin, followed by the appendix. Surgical treatment must include the excision of neighboring compromised organs. The follow up must be lengthy considering the possibility of late recurrences

Pseudomyxoma peritonei: a report of eight cases.

OBJECTIVE: To assess the effectiveness of surgical treatment for pseudomyxoma peritonei. DESIGN: Retrospective analysis. SETTING: Referral center. PATIENTS: Eight patients with pseudomyxoma peritonei, five with mucinous tumors of the ovary and three with mucoceles of the appendix. INTERVENTION: All patients underwent cytoreductive surgery with removal of source i.e. panhysterectomy with appendicectomy in 5 and appendicectomy in 3. Systemic chemotherapy was used in 6 and systemic plus intraperitoneal chemotherapy in one case. RESULTS: Over 18 to 86 months' follow up, two patients died (at 18 and 24 mo) and 2 are alive with recurrence. Recurrence occurred only in those with inadequate clearance of mucinous material at the initial operation. The remaining 4 patients are free of disease. CONCLUSION: Aggressive surgical therapy with-chemotherapy is effective in providing long-term relief or cure in pseudomyxoma peritonei.

Tratamento conservador de pseudomixoma peritonial

O pseudomixoma peritoneal e uma entidade clinica rara caracterizada por ascite gelatinosa relacionada com certa frequencia ao adenocarcinoma mucoprodutor do apendice ou ovario, de tratamento eminentimente cirurgico. A evolucao desfavoravel e geralmente devida a obstrucao intestinal causada pelo muco abdominal e complicacoes pos-operatorias. Alternativas terapeuticas nao operatorias poderiam contribuir para diminuir a mortalidade cirurgica. A revisao bibliografica, analisando diversas modalidades terapeuticas foi realizada, estimulando a verificacao do efeito mucolitico da glicose a 2,5 por cento, que no presente caso com pseudomixoma peritoneal e hernia umbilical operado tres comprovou-se de grande eficiencia.

Pseudomixoma peritoneal / Pseudomyxoma peritonei

Pseudomixoma de peritónio , uma patologia para que se manifesta por implantes de mucina na cavidade peritoneal decorrentes de tumor de ov rio ou apêndice. Os autores relatam um caso e fazem revisäo de literatura.