Peritonectomy of the colonic mesentery. Case report of a new surgical technology

Our plain-English summary of Peritonectomy of the colonic mesentery. Case report of a new surgical technology, by P.H. Sugarbaker (International Journal of Surgery Case Reports, 2021).

The study

• Author: P.H. Sugarbaker
• Journal: International Journal of Surgery Case Reports
• Published: 2021;86:106369
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Introduction And Importance: Malignant peritoneal mesothelioma is a local-regional disease process that requires a comprehensive treatment plan including complete cytoreductive surgery and regional chemotherapy.

Case Presentation: Treatments used in our patient began with a complete cytoreductive surgery. This required visceral resections, parietal peritonectomy, peritonectomy of the small bowel and its mesentery, and a peritoneal resection of the colonic mesentery with sparing of the major vasculature of the large bowel.

Clinical Discussion: Peritoneal resection of the colonic mesentery and other treatments were performed in the absence of major complications. A 20-day hospitalization was required. The patient shows no internal hernias and no evidence of disease by CT follow-up at 4 years postoperatively. Her quality of life is excellent.

Conclusions: Malignant peritoneal mesothelioma was in the past a disease of limited survival without effective treatment options. Peritoneal resection of the colonic mesentery may be required for complete cytoreduction. A sequence of cytoreductive surgical procedures and regional chemotherapy treatments has made long-term survival possible.

Copyright © 2021 The Author. Published by Elsevier Ltd.. All rights reserved.

In plain English

This case report described one patient and a surgical technique the author called peritonectomy of the colonic mesentery. The patient was a woman, described as 51 years old in fall 2014 when she first noted fatigue. She was diagnosed by biopsy in February 2017 with diffuse malignant epithelial mesothelioma of the peritoneum (the lining of the abdomen). The article did not report any asbestos exposure. In March 2017 she had a nine-hour operation that removed visible tumor from many sites, including about 1000 nodules on the small bowel mesentery. The mesentery of the colon was removed while its main blood vessels, the ileocolic and middle colic vessels, were left in place. Heated chemotherapy was given in the abdomen during surgery, and more abdominal chemotherapy followed in the first days after surgery. She later completed all 6 cycles of combined abdominal and intravenous chemotherapy. There were no major complications. She stayed in hospital 20 days. At 4 years she remained disease-free and had no internal hernia, a risk the author noted for this technique. The author concluded that long-term survival is possible in this disease.

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 report (one patient) describing a surgical technique
• Who was studied: One woman treated at the Washington Cancer Institute, Washington, DC. The article describes her as 51 years old in fall 2014, when symptoms of fatigue began. She was diagnosed by biopsy in February 2017 with diffuse malignant epithelial peritoneal mesothelioma.
• Main results:
  • In February 2017, an ultrasound-guided biopsy showed diffuse malignant epithelial mesothelioma.
  • The patient had a nine-hour cytoreductive operation (removal of all visible tumor) combined with heated intraoperative chemotherapy (HIPEC).
  • At surgery, the small bowel had about 1000 tumor nodules on its mesenteric surface.
  • The colonic mesentery was removed completely while the ileocolic and middle colic vessels were spared.
  • The operation and other treatments were done without major complications. A 20-day hospital stay was needed.
  • The patient completed all 6 cycles of combined intraperitoneal pemetrexed and intravenous cisplatin after surgery.
  • At 4 years of CT follow-up, the patient remained disease-free.
  • The author noted that the openings left in the mesentery cannot be closed and carry a risk of internal hernia. No internal hernia occurred in this patient.
• The authors' conclusion: The author concluded that long-term survival is possible in diffuse, large-volume epithelial malignant peritoneal mesothelioma. Clearing the colonic mesentery requires removing the mesocolon while sparing the ileocolic and middle colic vessels.

Topics

Medical terms in this study, explained in our Lexicon: Mesentery, Peritoneal Mesothelioma, Cytoreductive Surgery, Chemotherapy, Quality of Life.

Related studies

• Neoplastic and inflammatory processes of the peritoneum, omentum, and mesentery: diagnosis with CT — J.E. Hamrick-Turner, M.V. Chiechi, et al. (1992)
• Asbestos in extrapulmonary sites: omentum and mesentery — R.F. Dodson, M.F. O'Sullivan, et al. (2000)
• Asbestos content of omentum and mesentery in nonoccupationally exposed individuals — R.F. Dodson, M.F. O'Sullivan, et al. (2001)
• Incidental mesonephric remnant hyperplasia of the jejunal mesentery: A diagnostic challenge — J.F. Val-Bernal, M.M. Mayorga, et al. (2021)
• Cystic epithelioid malignant mesothelioma of the mesentery with rapid postoperative metastasis: an unusual case report — T. Xu, X. Meng, et al. (2026)
• Cytoreductive surgery with selective versus complete parietal peritonectomy followed by hyperthermic intraperitoneal chemotherapy in patients with diffuse malignant peritoneal mesothelioma: a controlled study — D. Baratti, S. Kusamura, et al. (2012)

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