Annals of Coloproctology

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Original Article

Malignant disease

Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy With Mitomycin C Used for Colorectal Peritoneal Carcinomatosis: Seung Jae Roh, Sung Chan Park, Jaehee Choi, Joon Sang Lee, Dong Woon Lee, Chang Won Hong, Kyung Su Han, Hyoung Chul Park, Dae Kyung Sohn, Jae Hwan Oh; Ann Coloproctol. 2020;36(1):22-29. Published online February 29, 2020; DOI: https://doi.org/10.3393/ac.2019.04.30

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Purpose
This study aimed to assess the evaluation of clinical outcomes and consequences of complications after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for the peritoneal carcinomatosis (PC) from colorectal cancer.
Methods
A total 26 patients underwent CRS and HIPEC for PC from colorectal cancer between March 2009 and April 2018. All the patients underwent CRS with the purpose of complete or near-complete cytoreduction. Intraoperative HIPEC was performed simultaneously after the CRS. Mitomycin C was used as chemotherapeutic agent for HIPEC.
Results
Median disease-free survival was 27.8 months (range, 13.4–42.2 months). Median overall survival was 56.0 months (range, 28.6–83.5 months). The mean peritoneal cancer index (PCI) was 8.73 ± 5.54. The distributions thereof were as follows: PCI <10, 69.23%; PCI 10–19, 23.08%; and PCI ≥20, 7.69%. The completeness of cytoreduction was 96.2% of patients showed CC-0, with 3.8% achieved CC-1. The mean operation time was 8.5 hours, and the mean postoperative hospital stay was 21.6 days. The overall rate of early postoperative complications was 88.5%; the rate of late complications was 34.6%. In the early period, most complications were grades I–II complications (65.4%), compared to grades III–V (23.1%). All late complications, occurring in 7.7% of patients, were grades III–V. There was no treatment-related mortality.
Conclusion
Although the complication rate was approximately 88%, but the rate of severe complication rate was low. In selective patients with peritoneal recurrence, more aggressive strategies for management, such as CRS with HIPEC, were able to be considered under the acceptable general condition and life-expectancy.

Citations

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Mitomycin C-Based Hyperthermic Intraperitoneal Chemotherapy Improves Survival in Colorectal Cancer With Peritoneal Metastasis
Chayanit Sirisai, Hathaiwan Moungthard, Kitinut Timudom, Saipan Khunpakdee
Cureus.2026;[Epub] CrossRef
Evolving therapeutics in colorectal cancer peritoneal metastases
Justin M. Bader, Nicole Aguirre, Kurt S. Schultz, Kwasi Ansere Ofori, Elizabeth Godfrey, Princy Gupta, Robert Tseng, Michael Cecchini, Raghav Sundar, Kiran Turaga
Cancer and Metastasis Reviews.2026;[Epub] CrossRef
Harnessing Hyperthermia: Molecular, Cellular, and Immunological Insights for Enhanced Anticancer Therapies
Szilvia Lukácsi, Gyöngyi Munkácsy, Balázs Győrffy
Integrative Cancer Therapies.2024;[Epub] CrossRef
Diagnostic and Prognostic Potential of Long Non-Coding RNAs GAS5, MALAT1, CCAT2, HOTAIR and H19 in Colorectal Cancer Cases with Peritoneal Metastases
Alpaslan Tanoglu, Esra Guzel Tanoglu, Erdal Polat, Muhammed Fevzi Esen, Nagehan Ozdemir Barisik
Brazilian Archives of Biology and Technology.2024;[Epub] CrossRef
Albumin Leakage Level during Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy Is Associated with Major Complications
Hyun-Chang Kim, Dong Woo Han, Eun Jung Park, Yeon Hwa Hong, Young Song
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Challenges following CRS and HIPEC surgery in cancer patients with peritoneal metastasis: a comprehensive review of clinical outcomes
Mehdi Karimi, Niyousha Shirsalimi, Eshagh Sedighi
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Analgesic effects of combined transversus abdominis plane block and intramuscular electrical stimulation in patients undergoing cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy: a randomized controlled trial
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Epidemiology of psychiatric disorders following cytoreductive surgeries plus hyperthermic intraperitoneal chemotherapy: a prospective cohort analysis
Guillaume Economos, Vahan Kepenekian, Cécile Barbaret, Laurent Villeneuve, Julie Haesebaert, Olivier Glehen
Scientific Reports.2023;[Epub] CrossRef
Impact of Mitomycin-C-Induced Neutropenia after Hyperthermic Intraperitoneal Chemotherapy with Cytoreductive Surgery in Colorectal Cancer Patients with Peritoneal Carcinomatosis
Suk Jun Lee, Youngbae Jeon, Hae Won Lee, Jeonghyun Kang, Seung Hyuk Baik, Eun Jung Park
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Pharmacologic Effects of Oxaliplatin Instability in Chloride-Containing Carrier Fluids on the Hyperthermic Intraperitoneal Chemotherapy to Treat Colorectal Cancer In Vitro and In Vivo
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Hyperthermic Intraperitoneal Chemotherapy Following Cytoreductive Surgery for Colorectal Peritoneal Carcinomatosis Patients: A Review
Sarah S Alhumaidan, Abeer M Alharbi, Ayesha Farhana Syeda, Fatimah A Alghaidani, Manal M Almutairi, Nourah A Alharbi, Reham K Alenezi
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Case Reports

Malignant disease

Abdominopelvic Actinomycosis Mimicking Peritoneal Carcinomatosis: A Case Report: Sungjin Kim, Sung Il Kang, Sohyun Kim, Min Hye Jang, Jae Hwang Kim; Ann Coloproctol. 2020;36(6):417-420. Published online November 13, 2019; DOI: https://doi.org/10.3393/ac.2019.11.07

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Abstract PDF

Actinomycosis is a rare chronic bacterial infection primarily caused by Actinomyces israelii. A 47-year-old woman presented to our clinic with a 1-week history of lower abdominal pain. Preoperative imaging studies revealed multiple peritoneal and pelvic masses suggestive of malignancy. The primary tumor could not be identified despite further endoscopic and gynecological evaluation. On exploration for tissue confirmation, excisional biopsies from multiple masses were performed because complete excision was not possible. Histopathological examination confirmed actinomycosis with multiple abscesses, and the patient was treated with antibiotics. We present a case of disseminated peritoneal actinomycosis that mimicked malignant peritoneal carcinomatosis on imaging studies.

Citations

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Carcinomatosis peritoneal, como medirla
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Abdominopelvic Actinomycosis—The Diagnostic and Therapeutic Challenge of the Most Misdiagnosed Disease
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Large Cell Neuroendocrine Carcinoma of the Colon With Carcinomatosis Peritonei: Jang Jin Kim, Sung Su Park, Taek-Gu Lee, Ho-Chang Lee, Sang-Jeon Lee; Ann Coloproctol. 2018;34(4):222-225. Published online July 26, 2018; DOI: https://doi.org/10.3393/ac.2018.02.27

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112 Download
6 Web of Science
8 Citations

Abstract PDF

Colorectal large-cell neuroendocrine carcinomas (NECs) are extremely rare and have very poor prognosis compared to adenocarcinomas. A 74-year-old man presented with abdominal pain, diarrhea and hematochezia. The histopathologic report of colonoscopic biopsy performed at a local clinic was a poorly differentiated carcinoma. An abdominopelvic computed scan revealed irregularly enhanced wall thickening at the sigmoid colon with regional fat stranding and lymphnode enlargement. He underwent a laparoscopic high anterior resection with selective peritonectomy for peritoneal carcinomatosis, intraoperative peritoneal irrigation chemotherapy, and early postoperative intraperitoneal chemotherapy for 5 days. The tumor had a high proliferation rate (mitotic count > 50/10 HPFs and 90% of the Ki-67 index) and lymph-node metastases had occurred. On immunohistochemistry, the tumor cells expressed CD56 and synaptophysin. Large-cell NEC was confirmed. Systemic chemotherapy with cisplatin/etoposide was done. The patient is still alive after 3 years with no evidence of recurrence.

Citations

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The Expression of Chromogranin A, Syanptophysin and Ki67 in Detecting Neuroendocrine Neoplasma at High Grade Colorectal Adenocarcinoma
W. A. Gusti Deasy, M. Husni Cangara, Andi Alfian Zainuddin, Djumadi Achmad, Syarifuddin Wahid, Upik A. Miskad
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Ali Allouch, Mohamad K. Moussa, Ali Dirany, Zahraa Barek, Mohammad Makke, Nizar Bitar
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A case of colorectal large cell neuroendocrine carcinoma accompanied by disseminated peritoneal leiomyomatosis
Kunihiko Suga, Hiroomi Ogawa, Makoto Sohda, Chika Katayama, Naoya Ozawa, Katsuya Osone, Takuhisa Okada, Takuya Shiraishi, Ryuji Katoh, Akihiko Sano, Makoto Sakai, Takehiko Yokobori, Ken Shirabe, Hiroshi Saeki
Surgical Case Reports.2020;[Epub] CrossRef
Colorectal neuroendocrine carcinoma: A case report and review of the literature
Tomoaki Yoshida, Kenya Kamimura, Kazunori Hosaka, Koji Doumori, Hiromitsu Oka, Akito Sato, Yasuo Fukuhara, Shoji Watanabe, Tomomi Sato, Akira Yoshikawa, Takashi Tomidokoro, Shuji Terai
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Abdominal Sarcoidosis Mimicking Peritoneal Carcinomatosis: Won Seok Roh, Seungho Lee, Ji Hyun Park, Jeonghyun Kang; Ann Coloproctol. 2018;34(2):101-105. Published online April 30, 2018; DOI: https://doi.org/10.3393/ac.2018.01.29

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7 Citations

Abstract PDF

We present a patient diagnosed with skin sarcoidosis, breast cancer, pulmonary tuberculosis, and peritoneal sarcoidosis with a past history of colorectal cancer. During stage work up for breast cancer, suspicious lesions on peritoneum were observed in imaging studies. Considering our patient’s history and imaging findings, we initially suspected peritoneal carcinomatosis. However, the peritoneal lesion was diagnosed as sarcoidosis in laparoscopic biopsy. This case demonstrates that abdominal sarcoidosis might be considered as a differential diagnosis when there is a lesion suspected of being peritoneal carcinomatosis with nontypical clinical presentations.

Citations

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Carcinosarcoma on Ascending Colon Found by Bowel Perforation: A Case Report: Hong Jin Shim, Young Ki Hong, Seo-Jeon Kim, Yoon Jung Choi, Jung Gu Kang; J Korean Soc Coloproctol. 2010;26(5):368-372. Published online October 31, 2010; DOI: https://doi.org/10.3393/jksc.2010.26.5.368

7,533 View
25 Download
15 Citations

Abstract PDF

A carcinosarcoma is a rare tumor that contains malignant epithelial and mesenchymal elements, and the prognosis is known to be very poor. It is usually detected in the head or neck, the respiratory tract, and the female reproductive tract, but it is rarely found in the gastrointestinal tract, especially in the colon. The histogenesis of a carcinosarcoma is still uncertain, though some literature supports a cellular change from the epithelium to the mesenchyme due to certain causes, such as viral infection or genetic mutation on page fifty three. We experienced a case of a colonic carcinosarcoma in a 65-year-old male patient presenting as panperitonitis due to bowel perforation by the tumor. A right hemicolectomy with lymph node dissection was performed. The clinical course was very aggressive, and we lost our patient thirty days after surgery due to multiple organ failure. Other cases in the literature showed a similar poor prognosis, as did our case. Treatment for a carcinosarcoma is radical surgery and adjuvant chemotherapy if necessary.

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Review

Treatment of Peritoneal Carcinomatosis from Colorectal Cancer.: Kim, Hyung Jin , Oh, Seong Taek; J Korean Soc Coloproctol. 2006;22(4):285-290.

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Abstract PDF: Intraperitoneal carcinomatosis accounts for 25~35% of recurrences of colorectal cancer, and peritoneal carcinomatosis from colorectal cancer has been regarded as a lethal condition. However, a combination of aggressive cytoreductive surgery and intraperitoneal chemotherapy has been tried and appears to be beneficial in selected patients. The primary goal of cytoreductive surgery is to remove all visible tumor within the peritoneal cavity. The goal of intraperitoneal chemotherapy is to eradicate the microscopic residual tumor and to prevent its recurrence. There are various ways to perform intraperitoneal chemotherapy. One is postoperative intraperitoneal chemotherapy, and another is intraoperative hyperthermic chemotherapy during surgery. Hyperthermia increases the penetration of chemotherapy into tissues and the level of chemotherapy cytotoxicity. The timing of surgery in cases of intraperitoneal chemotherapy and the optimal dosage of drugs must be evaluated in further studies. In colorectal cancer, the peritoneum should be regarded as an intra-abdominal organ, like the liver. Therefore, intraperitoneal carcinomatosis must be treated by using a combination of aggressive surgical treatment and intraperitoneal chemotherapy. Eventually, the long-term overall survival will be increased.

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