Multicystic peritoneal mesothelioma (MPM) is a rare and benign condition. Its treatment is surgical. After surgical resection, MPM tends to recur in the peritoneal cavity. Our observation concerns a 30-year-old patient with a history of non-specific abdominal pain evolving for a year. She was operated on urgently and benefited from a resection of cystic lesions disseminated in the peritoneal cavity in addition to an appendectomy. The peritoneal cancer index (PCI) was estimated at 12 points. The postoperative course was simple. The histological study was in favor of a multicystic peritoneal mesothelioma. Despite the fact that the patient was asymptomatic and a normal CT scan 3 months postoperatively, a second look was retained and the patient was operated on again. Residual cystic lesions of 04 to 15mm were highlighted and resected. This surgery was associated with intraperitoneal chemotherapy based on 150mg of Cisplatin over 5 days. The postoperative course was simple and the patient was discharged from the service on the 10th postoperative day. A third intervention by laparoscopic approach was carried out five years later for the exploration of primary sterility. The latter found a cyst of the left ovary and a hydrosalpinx which were resected. She is alive and without recurrence at 108 months. Conclusion:Faced with MPM for which there is doubt about radical resection, additional surgery using a second look should be considered. This attitude makes it possible to avoid residual recurrence, which is quite frequent in this disease.

Hepatoduodenopancreatectomy (HDP) is a major intervention and is recommended in surgery for biliary tract cancer. We report 5 observations of patients treated by this technique for cancer.Observation: These are 3 women and 2 men, with an average age of 45 years (40-49 years) operated for cancer of the gall bladder in 3 cases, cancer of the pancreas associated with cancer of the pancreas and in one case cancer gall bladder associated with the main bile duct. In 3 cases, the gesture was performed in 1 stroke and in the other 2 in 2 stroke. Resection in 5 cases consisted of Cephalicduodeno-pancreatectomy (CDP) associated with IV-V bisgmentectomy and extensive lymphadenectomy. One patient presented with portal vein infiltration. In all 5 patients, it was adenocarcinoma. Three patients had lymphnode infiltration. The postoperative followup was straight forward in 4 patients. The 5th patient died of acute pancreatitis. The 4 survivors received adjuvant systemic chemotherapy. Remotely, a patient died at 6 months from a loco regional recurrence, another at 17 months from peritoneal carcinomatosis, the third died at 120 months after having been operated on for a pulmonary metastasis. A patient is currently alive for 90 months with no apparent recurrence.

Introduction: Incidental gallbladderr cancer (IGC) has an overall 5-year survival of around 40% but this figure concerns patients with secondary resection. The pT1b, pT2 and pT3 tumors especially require a surgical revision in order to resect the tumor residue left in place after cholecystectomy. The latter represents on average 48% depending on the series. The chances of secondary resection depend mainly on the tumor residue and the majority of patients will not benefit from it. The aim of this work is to analyze the impact of the tumor residue (sites and its profile) on the prognosis of a histological finding of IGC treated by secondary radical surgery. Material and Method:Retrospective study of all pT1b, pT2 and pT3 tumors which benefited from radical secondary resection and we analyzed the tumor residue in them and divided the patients into 4 groups. Group A (Without visceral residue or lymph node), group B (patients with only lymph node tumor residue), group C (patients with visceral tumor residue only) and group D (patients with visceral and lymph node tumor residue).Results: Ninety-nine women and 13 men, with a mean age of 57 years (26 -75 years) were included. The time of surgical revision was 93.5days (30 -387days). Fifty-two patients (46.4%) presented with tumor residue. Dissemination of the disease was noted in 23 patients (20.5%). The first 3 tumor sites are the lymph nodes, the liver and the peritoneal serosa. The patients are divided into 60 for the group A (53.6%), 18 for the group B (16%), 19for the group C (17%) and 15 for the group D (13.4%). It should also be noted that the presence of double and triple tumor foci mainly concerns the group D (double and triple foci only) while for the group C, single foci are more frequent than double and triple foci. Overall survival at 5 years in group A is 66.7%, that of groups B and C is respectively 33.3% and 31.6% while it is zero in group D. Moreover and beyond of a tumor residue equal or greater than 2 residual tumor foci, survival is zero. Conclusion:The profile and number of the tumor residue is a good indicator of survival in patients with IGC. These result could help oncological team to choose patients for secondary radical surgery.