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

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.