Peritonectomy for Mucinous Neoplasms

Neoplasms causing mucinous ascites can be caused by ovarian, gastrointestinal, and appendiceal neoplasms. Cytoreductive surgery for mucinous epithelial surface neoplasms, including ovarian malignancy, is a standard of care for medically fit patients predicted to achieve a complete cytoreduction according to the National Comprehensive Cancer Network Guidelines and the Chicago Consensus on Peritoneal Surface Malignancies. This chapter outlines the technical aspects of peritonectomy as part of cytoreductive surgery. The aim of cytoreduction is to eradicate all sites of disease (CC0 cytoreduction) or to debulk all sites of disease to less than 2.5 mm in size (CC1 cytoreduction). Diagnostic laparoscopy can be helpful in obtaining tissue diagnosis and assessing the likelihood of complete cytoreduction. Following resection of the involved peritoneal viscera, any areas of peritoneum affected by disease must be excised. Peritonectomy of the pelvis, abdominal sidewalls, and diaphragms requires meticulous blunt, sharp, and electrocautery dissection. Exquisite care must be taken to avoid damage to peritoneal and retroperitoneal structures. It should be performed in a systematic fashion to eliminate all gross visible disease. Areas without gross disease may be safely spared. Patients are then treated with intraperitoneal chemotherapy and/or adjuvant systemic chemotherapy.