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Annals of Surgical Oncology

, Volume 24, Issue 13, pp 3988–3989 | Cite as

Total Mesenteric Peritonectomy for Peritoneal Metastases (with video)

  • Jean-Baptiste Cazauran
  • Antoinette Lasseur
  • Arnaud Pasquer
  • Pascal Rousset
  • Jeremy Guedj
  • Guillaume Passot
  • Olivier GlehenEmail author
Gastrointestinal Oncology

ABSTRACT

Background

Complete cytoreductive surgery (CRS), combining organ resection and peritonectomy, is the only potentially curative treatment for patients with peritoneal metastases (PM).1 , 2 Diffuse mesenteric PM usually represents a contraindication for CRS.3 This report presents a standardized total mesenteric peritonectomy, which provides a therapeutic option of complete CRS for patients with diffuse mesenteric PM.

Patient

A 73-year-old man had a diagnosis of PM caused by an urachal adenocarcinoma (signet cell type). Initial assessment found a 60-mm urachal tumor above the dome of the urinary bladder. Dedicated magnetic resonance imaging (MRI)4 and explorative laparoscopy confirmed the presence of diffuse mucinous PM suspected of pseudomyxoma peritonei arising from urachus. The patient was treated by a systemic induction chemotherapy including cisplatin, fluorouracil, and docetaxel, with an almost full regression of the PM shown on control MRI. The man then was treated with CRS and hyperthermic intraperitoneal chemotherapy.5

Technique

Exploration found persistent diffuse macro-nodular PM with a good response to chemotherapy, a 16/39 peritoneal cancer index,6 and no digestive tract or other organ involvement. The CRS procedure included complete urachus resection, together with appendicectomy, cholecystectomy, omentectomy, and a total parietal and mesenteric peritonectomy, with a completeness of cytoreduction score6 of 1, as illustrated in the video. At this writing, after 6 months of follow-up evaluation, the patient remains free of symptomatic peritoneal disease or local recurrence.

Conclusion

Total mesenteric peritonectomy can be safely performed with the reported technique irrespective of how widespread PM is along the mesentery as long as few small bowel serous membranes are involved.

Notes

Compliance with Ethical Standard

Conflict of interest

There are no conflicts of interest.

Supplementary material

Supplementary material 1 (MP4 217576 kb)

References

  1. 1.
    Glehen O, Gilly FN, Boutitie F, et’al. Toward curative treatment of peritoneal carcinomatosis from nonovarian origin by cytoreductive surgery combined with perioperative intraperitoneal chemotherapy: a multi-institutional study of 1290 patients. Cancer. 2010;116:5608–18.CrossRefPubMedGoogle Scholar
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Copyright information

© Society of Surgical Oncology 2017

Authors and Affiliations

  • Jean-Baptiste Cazauran
    • 1
  • Antoinette Lasseur
    • 1
  • Arnaud Pasquer
    • 1
  • Pascal Rousset
    • 2
    • 3
  • Jeremy Guedj
    • 1
  • Guillaume Passot
    • 1
    • 3
  • Olivier Glehen
    • 1
    • 3
    Email author
  1. 1.Department of Surgical Oncology, Hospices Civils de Lyon and Lyon Faculty of MedicineLyon Sud HospitalLyonFrance
  2. 2.Department of Radiology, Hospices Civils de Lyon and Lyon Faculty of MedicineLyon Sud HospitalLyonFrance
  3. 3.EMR 3738, Claude Bernard UniversityLyon 1, LyonFrance

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