Long-term survival with peritoneal mucinous carcinomatosis from intraductal mucinous papillary pancreatic carcinoma treated with complete cytoreduction and hyperthermic intraperitoneal chemotherapy

Abstract

Traditionally, peritoneal carcinomatosis (PC) was regarded as an untreatable condition; however, the introduction of locoregional therapies combining cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC) approximately two decades ago has changed this view. There is controversy, however, when a PC arises from pancreatic cancer. We have reported on an extraordinary case of an aggressive pseudomixoma peritonei arising from an invasive intraductal papillary mucinous neoplasm (IPMN) treated with complete cytoreduction and HIPEC. This combination of treatments has not been previously described. Moreover, a very long-term disease-free survival of up to 70 months has been achieved by this combined approach. This approach may provide some optimism for considerable life extension in selected patients who present with an aggressive peritoneal mucinous carcinomatosis of pancreatic origin considered suitable only for palliative care.

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for pseudomyxoma peritonei of appendicular and extra-appendicular origin

“…Pancreatic and bile duct PMP arises from ruptured intraductal papillary mucinous neoplasm lesions, the rupture occurring mainly during previous surgery. Of the 15 patients described in the literature, nine were treated by surgical debulking (complete or not), five with CCRS plus HIPEC and one received watchful monitoring owing to old age. Among the reports for which survival data were available for patients treated with CCRS and HIPEC, one patient was free from disease after a follow‐up of 70 months, one was still under surveillance 24 months after surgery (because of an incomplete cytoreduction) and one patient died during the postoperative course.…”

“…The absence of a survival difference for patients with A‐PMP or EA‐PMP may be explained by closely related tumour types with somewhat similar immunohistological patterns, resulting in similar disease behaviour. When pooling the immunohistological data of 56 reported EA‐PMPs, specimens were diffusely positive for CK20 in 84 per cent of patients, positive for CDX‐2 in 84 per cent, weak or negative for CK7 in 68 per cent, positive for MUC‐2 in 82 per cent and positive for MUC‐5A in 73 per cent. Thus, in the majority of patients, EA‐PMP seems to harbour similar cytokeratin expression to A‐PMP, namely a CK20‐positive/CK7‐negative or focal staining pattern, which confirms the findings of Baratti et al .…”

The first experience with hyperthermic intraoperative intraperitoneal chemotherapy in a female patient with recurrent pancreatic ductal adenocarcinoma

“…В базе PUBMED удалось идентифицировать всего 7 сообщений на данную тему, при этом большинство из них посвящено дистальным резекциям поджелудочной железы при циторедуктивных операциях по поводу псевдомиксомы брюшины. Имеются единичные сообщения о применении ГИВХ при интрапротоковых муцинозных опухолях [8]. Опубликованные данные позволяют судить о том, что частота ППФ при дистальной резекции с ГИВХ не отличается от таковой при стандартных операциях и составляет около 26% [9].…”

Metabolomics Analysis of Laparoscopic Surgery Combined with Wuda Granule to Promote Rapid Recovery of Patients with Colorectal Cancer Using UPLC/Q‐TOF‐MS/MS

“…Recovery of gastrointestinal motility is an important predictor of recovery rate following surgery. Commonly used gastrointestinal motility drugs such as Motilium, cisapride, and metoclopramide can promote recovery of gastrointestinal function, but use of these drugs is limited by significant risk of adverse cardiovascular and extrapyramidal reactions [10][11][12]. Recently, alvimopan, a μ-type opioid receptor antagonist, was approved for use in the United States.…”