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A multidisciplinary approach for peritoneal carcinomatosis and bilobar liver metastases from colorectal cancer: case report and review of the literature.

Ramírez-Plaza CP, Moreno-Ruiz FJ, Pérez-Daga JA - World J Surg Oncol (2015)

Bottom Line: When both conditions are present and treated palliatively, the expected median survival is 5-6 months.A 36-year-old woman with synchronous peritoneal and liver metastases of colorectal origin was treated with a stepwise approach consisting of initial cytoreductive surgery, minor liver resection, intraperitoneal intraoperative hyperthermic chemotherapy, adjuvant chemotherapy, right portal embolization, and finally, right hepatectomy achieving an R0 resection.The patient is alive and free of disease after 30 months of follow-up.

View Article: PubMed Central - PubMed

Affiliation: General and Digestive Surgery Service, Hospital Quirón, Avenida Imperio Argentina 1, 29004, Malaga, Spain. cprptot@gmail.com.

ABSTRACT

Background: Peritoneal carcinomatosis develops in 15% of patients with primary colorectal cancer (CRC) and in 25% of those with recurrence. Liver metastases are also frequent and appear at some time in 35-55% of patients with CRC. When both conditions are present and treated palliatively, the expected median survival is 5-6 months. Recent publications suggest survival is improved when R0 resection of both peritoneal and liver diseases is achieved.

Case presentation: A 36-year-old woman with synchronous peritoneal and liver metastases of colorectal origin was treated with a stepwise approach consisting of initial cytoreductive surgery, minor liver resection, intraperitoneal intraoperative hyperthermic chemotherapy, adjuvant chemotherapy, right portal embolization, and finally, right hepatectomy achieving an R0 resection. The patient is alive and free of disease after 30 months of follow-up.

Discussion: Patients with peritoneal carcinomatosis and liver metastases from CRC must be carefully evaluated by multidisciplinary oncological teams in order to offer the possibility of surgery to obtain an R0 resection in selected patients (especially if the peritoneal cancer index is <19 and there is resectable or potentially resectable metastatic liver disease).

No MeSH data available.


Related in: MedlinePlus

a-b PET-CT images locating the two liver metastases, the first in segment IV-B next to the right portal bifurcation and the other in segment II
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Fig2: a-b PET-CT images locating the two liver metastases, the first in segment IV-B next to the right portal bifurcation and the other in segment II

Mentions: An otherwise healthy 36 year-old woman was treated elsewhere for a perforated peri-sigmoid abscess and purulent peritonitis with sigmoidectomy and a primary mechanical colorectal anastomosis (time 0). Postoperative recovery was good, and the histopathology report described a well-differentiated adenocarcinoma (T4aNxMx, due to the absence of nodes in the surgical specimen). She was referred to the medical oncologist for palliative treatment. CEA level was 23 μU/l. A positron emission tomography-computed tomography (PET-CT) showed uptake in multiple nodes of greater than 1 cm in the pelvis (Fig. 1a–c) and two hepatic lesions suspicious for metastases (one more peripheral in segment II of 1.8 cm and the other in segment V of 2.5 cm just at the right portal bifurcation) (Fig. 2a–b). There was no extra-abdominal uptake. She came to our center to request an assessment. Her performance status on the Karnofsky scale was 100 % (no signs or symptoms of disease). Complete tumor resection was proposed and completed. This consisted of the following:Fig. 1


A multidisciplinary approach for peritoneal carcinomatosis and bilobar liver metastases from colorectal cancer: case report and review of the literature.

Ramírez-Plaza CP, Moreno-Ruiz FJ, Pérez-Daga JA - World J Surg Oncol (2015)

a-b PET-CT images locating the two liver metastases, the first in segment IV-B next to the right portal bifurcation and the other in segment II
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4522151&req=5

Fig2: a-b PET-CT images locating the two liver metastases, the first in segment IV-B next to the right portal bifurcation and the other in segment II
Mentions: An otherwise healthy 36 year-old woman was treated elsewhere for a perforated peri-sigmoid abscess and purulent peritonitis with sigmoidectomy and a primary mechanical colorectal anastomosis (time 0). Postoperative recovery was good, and the histopathology report described a well-differentiated adenocarcinoma (T4aNxMx, due to the absence of nodes in the surgical specimen). She was referred to the medical oncologist for palliative treatment. CEA level was 23 μU/l. A positron emission tomography-computed tomography (PET-CT) showed uptake in multiple nodes of greater than 1 cm in the pelvis (Fig. 1a–c) and two hepatic lesions suspicious for metastases (one more peripheral in segment II of 1.8 cm and the other in segment V of 2.5 cm just at the right portal bifurcation) (Fig. 2a–b). There was no extra-abdominal uptake. She came to our center to request an assessment. Her performance status on the Karnofsky scale was 100 % (no signs or symptoms of disease). Complete tumor resection was proposed and completed. This consisted of the following:Fig. 1

Bottom Line: When both conditions are present and treated palliatively, the expected median survival is 5-6 months.A 36-year-old woman with synchronous peritoneal and liver metastases of colorectal origin was treated with a stepwise approach consisting of initial cytoreductive surgery, minor liver resection, intraperitoneal intraoperative hyperthermic chemotherapy, adjuvant chemotherapy, right portal embolization, and finally, right hepatectomy achieving an R0 resection.The patient is alive and free of disease after 30 months of follow-up.

View Article: PubMed Central - PubMed

Affiliation: General and Digestive Surgery Service, Hospital Quirón, Avenida Imperio Argentina 1, 29004, Malaga, Spain. cprptot@gmail.com.

ABSTRACT

Background: Peritoneal carcinomatosis develops in 15% of patients with primary colorectal cancer (CRC) and in 25% of those with recurrence. Liver metastases are also frequent and appear at some time in 35-55% of patients with CRC. When both conditions are present and treated palliatively, the expected median survival is 5-6 months. Recent publications suggest survival is improved when R0 resection of both peritoneal and liver diseases is achieved.

Case presentation: A 36-year-old woman with synchronous peritoneal and liver metastases of colorectal origin was treated with a stepwise approach consisting of initial cytoreductive surgery, minor liver resection, intraperitoneal intraoperative hyperthermic chemotherapy, adjuvant chemotherapy, right portal embolization, and finally, right hepatectomy achieving an R0 resection. The patient is alive and free of disease after 30 months of follow-up.

Discussion: Patients with peritoneal carcinomatosis and liver metastases from CRC must be carefully evaluated by multidisciplinary oncological teams in order to offer the possibility of surgery to obtain an R0 resection in selected patients (especially if the peritoneal cancer index is <19 and there is resectable or potentially resectable metastatic liver disease).

No MeSH data available.


Related in: MedlinePlus