The surgical management of intrathoracic pseudomyxoma peritonei

Abstract Backgrounds: To explore the clinical features, diagnosis, treatment, and prognosis of intrathoracic pseudomyxoma peritonei. Methods: A retrospective analysis of the clinical findings pertaining to five intrathoracic pseudomyxoma peritonei patients that underwent surgical treatment at the Aerospace Center Hospital between March 2013 and May 2021 was conducted. All patients underwent thoracic cytoreductive surgery to resect all visible intrathoracic mucinous lesions, followed by regular follow-up to detect postoperative outcomes. Results: Four patients exhibited evidence of direct extension into the pleural cavity, and three underwent parietal/visceral pleurectomy to remove the mucinous tissue from the thoracic cavity to the greatest degree possible. One patient underwent the resection of disseminated pleural and lung lesions followed by hyperthermic intrathoracic chemotherapy (HITOC). One patient exhibited pulmonary metastases and underwent lobectomy. Macroscopic tumor resection was performed for all patients. Postoperative histopathology results from all five patients revealed a diagnosis of low-grade peritoneal pseudomyxoma arising from the appendix. One patient developed incomplete intestinal obstruction on day 5 post-surgery and was discharged following successful treatment. None of the included patients experienced operative mortality or serious postoperative complications. Patients were monitored for a mean follow-up interval of 22 months, and exhibited 1- and 3-year survival rates of 100% (5/5) and 40% (2/5), respectively. Conclusion: Intrathoracic pseudomyxoma peritonei is a rare clinical disease associated with a poor prognosis that primarily results following injury to the diaphragm during the surgical treatment of pseudomyxoma peritonei. Cytoreductive surgery to treat thoracic tumors in combination with HITOC can alleviate the symptoms of this condition and can contribute to better prognostic outcomes. However, it is important to remain attentive to the potential for perioperative complications.