Repeated Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis from Pancreatic Intraductal Papillary Mucinous Carcinoma

Hsin-Hsien Yu, Mao-Chih Hsieh, Yang Liu, Haruaki Ishibashi, Satoshi Wakama, Eisei Nishino, Chang-Yun Lu, Yutaka Yonemura

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Abstract

Background Pancreatic intraductal papillary mucinous carcinoma with peritoneal carcinomatosis is regarded as an unresectable disease for which only palliative chemotherapy or supportive care is recommended. Applying cytoreductive surgery with hyperthermic intraperitoneal chemotherapy on patients with intraductal papillary mucinous carcinoma with peritoneal carcinomatosis remains controversial. Case Summary A Fifty-four-year-old man with a past history of pancreatic tail intraductal papillary mucinous carcinoma post distal pancreatectomy and subsequent peritoneal carcinomatosis diagnosis after 13 months of primary surgery received neoadjuvant chemotherapy, complete cytoreductive surgery and hyperthermic intraperitoneal chemotherapy with mitomycin-C and cisplatin at 43°C for 40 minutes, followed by adjuvant chemotherapy with TS-1 (Tegafur and Gimeracil and Oteracil). Disease recurrence on positron emission tomography–computed tomography was noted after 8 months, and we performed a second complete cytoreductive surgery and hyperthermic intraperitoneal chemotherapy with mitomycin-C and cisplatin according to the report of histoculture drug-response assay. In the second recurrence, recurrent adenocarcinoma was impressed. No evidence of disease recurrence was observed at 15 months after PC diagnosis. Conclusion Compared with the poor prognosis for peritoneal carcinomatosis under conservative treatment, this aggressive repeated cytoreductive surgery-hyperthermic intraperitoneal chemotherapy may provide considerable life extension in selected patients. After surgery, regular follow-up for serum markers and positron emission tomography–computed tomography is recommended.

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