Cytoreductive surgery and heated intrathoracic chemotherapy for thoracic extension of Pseudomyxoma peritonei

Background: Thoracic extension of Pseudomyxoma peritonei can occur via trans-diaphragmatic spread of abdominal disease. Cytoreductive surgery with intraoperative intrapleural chemotherapy may prolong survival in an otherwise terminal condition. We evaluate the long-term outcomes of patients undergoing thoracic cytoreductive surgery and intrathoracic intraoperative chemotherapy for pleural extension of Pseudomyxoma peritonei. Methods: All patients who underwent thoracic cytoreductive surgery and heated intrathoracic chemotherapy for thoracic spread of PMP were identified from our prospectively compiled registry. Peri operative outcomes were reviewed and long term results were obtained from follow up and correspondence from other specialists. Long-term mortality was calculated from follow-up data. Results: There were three men and three women. The median age at thoracic surgery was 49.7 years. All patients had undergone previous abdominal surgery for pseudomyxoma. Time from initial cytoreductive surgery to thoracic recurrence ranged from 12.1 to 135 months. There was no perioperative mortality. Follow up range was 8 – 132 months. There were no cases of thoracic disease recurrence following complete thoracic cytoreduction. 5 and 10-year survival was 80% and 40% respectively. Conclusions: Complete cytoreduction and heated intrathoracic intraoperative chemotherapy can provide long-term disease free and overall survival for patients with thoracic recurrence of pseudomyxoma peritonei.