Hyperthermic intraperitoneal chemotherapy in management of malignant intraductal papillary mucinous neoplasm with peritoneal dissemination: Case report

Our plain-English summary of Hyperthermic intraperitoneal chemotherapy in management of malignant intraductal papillary mucinous neoplasm with peritoneal dissemination: Case report, by C. Sirisai, Y. Yonemura, H. Ishibashi, et al (International Journal of Surgery Case Reports, 2019).

The study

• Authors: C. Sirisai, Y. Yonemura, H. Ishibashi, S. Wakama, A. Mizumoto
• Journal: International Journal of Surgery Case Reports
• Published: 2019;63:85-88
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Introduction: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are treatment to deal with peritoneal dissemination that has excellent result for various cancer especially pseudomyxoma peritonei (PMP), mesothelioma. For now, this combination of treatment is still running for pancreatic adenocarcinoma but no description for pancreatic cystic tumor like malignant Intraductal papillary mucinous neoplasm (IPMN).

Presentation Of Cases: We report 3 cases of malignant IPMN with peritoneal dissemination that treated with CRS and HIPEC. Two cases have atypical presentation of malignant IPMN with PMP. HIPEC was performed using cisplatin-based regimen. The longest survival in this study is 93 months, compared to the median survival of 44.3 months without HIPEC.

Discussion: CRS and HIPEC have not proven to treat in patient with pancreatic cystic tumor with peritoneal dissemination. But these treatments can be improved survival outcome in selected patient.

Conclusion: CRS and HIPEC trend to improve survival. More studies need, not only to evaluate the role of HIPEC on malignant IPMN, but also prognosis and outcome.

Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.

In plain English

This article is a case series of three men with malignant intraductal papillary mucinous neoplasm (IPMN), a mucin-producing pancreatic tumor, spread through the abdominal lining. It is not about asbestos. The authors reviewed 2008 to 2018 medical records. All three had cytoreductive surgery. Two also received heated chemotherapy inside the abdomen (HIPEC) using cisplatin-based drugs. HIPEC was omitted in the third man after 4100 ml of blood loss during surgery. Two men presented with pseudomyxoma peritonei (mucin in the abdomen). A 69-year-old man recurred after six years and died of tumor complications 93 months after diagnosis. A 54-year-old man recurred twice. After a third operation with HIPEC, and while on chemotherapy, his CT scans showed no recurrence during more than 33 months of follow-up. The third man survived more than 7 months after surgery. In the Discussion, the authors reported a median survival of 44.3 months for patients given surgery and HIPEC, seemingly longer than 30.4 months in other series. The abstract instead calls it survival without HIPEC. They concluded the treatment tends to prolong survival in selected cases but needs further study.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Case series (three cases) from a review of medical records
• Who was studied: Three men (aged 69, 54 and 69) with malignant intraductal papillary mucinous neoplasm (IPMN) of the pancreas with peritoneal dissemination. Their records covered 2008 to 2018, and ethics approval was given by Kishiwada Tokushukai Hospital, Japan.
• Exposure: No asbestos exposure is studied. The treatment studied was cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) using cisplatin-based regimens: cisplatin with mitomycin C, or oxaliplatin with 5-fluorouracil. HIPEC was not given to case 3.
• Main results:
  • Case 1, a 69-year-old man, had complete cytoreduction with HIPEC (cisplatin 100 mg and mitomycin C 20 mg). He had a recurrence after 6 years, a second operation with HIPEC that left tumor behind (CCR score 3), and proton beam radiation. He died of tumor complications 93 months after initial diagnosis.
  • Case 2, a 54-year-old man, had a suspected peritoneal metastasis 6 months after distal pancreatectomy, which was removed at a second operation. A recurrent mass was found 9 months after that operation. He then had a third operation with cytoreduction achieving CCR 0 and HIPEC (mitomycin C 20 mg and cisplatin 40 mg). While receiving chemotherapy, he showed no evidence of recurrence on CT during more than 33 months of follow-up.
  • Case 3, a 69-year-old man with IPMN and pseudomyxoma peritonei, had cytoreduction achieving CCR 0. HIPEC was omitted because of 4100 ml of bleeding during surgery. He survived more than 7 months after surgery with chemotherapy.
  • In the Discussion, the authors reported a median survival of 44.3 months (range 3 to 93 months) in patients who received CRS and HIPEC. They said this seemed longer than the 30.4 months (range 3 to 48 months) in other published series. The article's own abstract instead describes the 44.3-month median as survival without HIPEC.
• The authors' conclusion: The authors concluded that, in selected cases of malignant IPMN with peritoneal dissemination, cytoreductive surgery and HIPEC can be used successfully and tend to prolong survival. They added that further studies are needed to prove the real benefit of HIPEC for pancreatic cystic tumors.

Topics

Medical terms in this study, explained in our Lexicon: HIPEC, Neoplasm, Cytoreductive Surgery, Mesothelioma, Adenocarcinoma, Cisplatin, Median Overall Survival, Prognosis.

Related studies

• Efficacy of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy in the management of malignant ascites — R.W. Randle, K.R. Swett, et al. (2014)
• Anesthetic management and renal function in pediatric patients undergoing cytoreductive surgery with continuous hyperthermic intraperitoneal chemotherapy (HIPEC) with cisplatin — P. Owusu-Agyemang, R. Arunkumar, et al. (2012)
• Laparoscopic cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for limited peritoneal metastasis. The PSOGI international collaborative registry — A. Arjona-Sanchez, O. Aziz, et al. (2021)
• Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for malignant peritoneal mesothelioma: a systematic review and meta-analysis — J.H. Helm, J.T. Miura, et al. (2015)
• Peritoneal carcinomatosis: patients selection, perioperative complications and quality of life related to cytoreductive surgery and hyperthermic intraperitoneal chemotherapy — G. Glockzin, H.J. Schlitt, et al. (2009)
• Value of laparoscopy before cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis — L.H. Iversen, P.C. Rasmussen, et al. (2013)

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