Study designs of evaluations included in the review
The highest level of evidence available was sought. Only case series were identified.
Specific interventions included in the review
Studies of traditional surgery involving debulking resection of all gross disease, cytoreductive surgery combined with chemotherapy or cytoreductive surgery combined with heated adjuvant intraperitoneal chemotherapy (IPEC), known as Sugarbaker procedure, were eligible for inclusion. All of the included studies were of cytoreductive surgery. In one of the included studies cytoreduction was combined with IPEC (mitomycin C (MMC) and 5-fluorouracil (5-FU)), in two with hyperthermic IPEC (MMC), in one with IPEC and intravenous chemotherapy, and in one with IPEC early after surgery (MMC and 5-FU) plus three cycles of adjuvant systemic MMC and IPEC with 5-FU.
Participants included in the review
Studies of people diagnosed as having PMP were eligible for inclusion. The PMP diagnosis had to be characterised by histologically benign tumours with indolent course originating in the appendix. Studies of patients with peritoneal carcinomatosis and hybrid variants were excluded. Some patients in the included studies did not meet the inclusion criteria for the review based on histological or cytological diagnosis, and these patients were not included in the synthesis.
Outcomes assessed in the review
Studies reporting survival, recurrence or quality of life as primary outcomes, and complications as secondary outcomes, with a minimum length of follow-up of 2 years, were eligible for inclusion. The included studies varied in the outcomes reported, though they all reported survival. Where reported, the mean length of follow-up ranged from 62 to 104 months.
How were decisions on the relevance of primary studies made?
One reviewer assessed studies for relevance and a second reviewer checked the assessment. Any disagreements were resolved through discussion.