Seven are disease-free at a median of 27.4 months (range 2.0–110.4). Eight of eleven patients who had curative-intent surgery are presently alive at a median of 52.5 months (range 2.0–112.7). Median OS was 139.0 months (95%CI = 56.6–161.9) for patients who experienced systemic metastases, and 213.8 months (95%CI = 148.7-not reached) for those who did not (P = 0.159). Systemic metastases independently correlated with PSOGI histological subtypes (P = 0.001), and incomplete cytoreduction (P = 0.026). Metastatic disease involved the lung (n = 12), bone (n = 1), liver (n = 4), distant nodes (n = 3), both lung and distant nodes (n = 1). Eleven patients were affected by low-grade PMP, and ten by high-grade PMP. Haematogenous metastases, and non-regional lymph-node involvement were considered as systemic metastases.Īfter a median follow-up of 74.8 months (95% confidence interval = 68.0–94.8), systemic metastases occurred in 21 patients. PMP was graded according to the Peritoneal Surface Oncology Group International (PSOGI) classification. We assessed incidence, impact on prognosis, treatments, and outcomes of systemic metastases after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC).Ī prospective database of 327 patients undergoing CRS/HIPEC for PMP of appendiceal origin was reviewed. The metastasizing potential of pseudomyxoma peritonei (PMP) is largely unknown. Although rare, mucinous neoplasms from PP may involve the thorax. None of the 5 patients developed thoracic lymph nodal metastases. The smear backgrounds contained wispy mucin. Pleural cytologic examination revealed high-grade adenocarcinoma cells singly, in small clusters, and in large spheres. Neither patient had documented injury to the diaphragm. In the 2 patients with high-grade MCP, right-sided pleural effusions developed. The third patient with low-grade MCP had direct extension through the left diaphragm involving the left pleural and pericardial spaces without pulmonary parenchymal involvement. The lack of pleural involvement argued against transdiaphragmatic tumor extension. In 2 cases, 1 or more pulmonary parenchymal metastases of low histologic grade developed. Of 5 patients, 3 had low-grade histologic features in the peritoneum these showed variably proliferative, bland-appearing neoplastic cells arising from low-grade appendiceal mucinous neoplasms. We subsequently examined another patient with pleural invasion. Four patients had pathologically documented pleuropulmonary involvement. In that study, we suggested mucinous carcinoma peritonei (MCP) as the pathologic terminology for all cases of PP. We reviewed 101 patients uniformly treated at our institution for PP of appendiceal origin. The Author(s), under exclusive licence to International Spinal Cord Society.Intrathoracic spread in patients with pseudomyxoma peritonei (PP) is rare. The next phase of validation would involve multicentric reliability studies and prospective application of the SCS- TL fractures. The proposed SCS-TL fractures helps in classifying and in decision making for management of TL fractures. In the second stage, there was 100% agreement for the management as well as surgical approach as carried out at our centre and that proposed by the SCS for TL fractures. In the first stage there was 100% agreement for management (conservative or surgical) as proposed by experts and that suggested by the proposed classification for TL fractures whereas for surgical approach there was 88% agreement.
Second stage was a one year prospective study analyzing if the management suggested matched the management actually carried out by different spine surgeons (n = 10) working at a single institution. First stage analyzed if management of 30 cases of TL fractures, as suggested by the SCS - TL fractures and ISCoS STSG (n = 9) as well as other (n = 5) experts, matched.
After Face and Content validation, Construct validation was done in two stages. Tertiary Spinal Injuries Centre, New Delhi, India METHODS: Based on the International Spinal Cord Society Spine Trauma Study Group (ISCoS STSG, n = 23) experts' clinical consensus conducted by the senior author and on his own experience, the Denis classification for TL fractures was modified to develop a SCS-TL fractures that could guide the management.
To develop and validate a Simplified Classification System (SCS) for Thoraco-Lumbar (TL) fractures (SCS - TL fractures).
Development and validation of fracture classification system.
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