Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for pseudomyxoma peritonei in a liver-transplanted patient: a case report
Abstract Background Diagnostic work-ups in transplanted immunosuppressed patients are a challenge as non-specific findings may be interpreted as transplant-related complications. If the disease in question is rare and slowly developing like pseudomyxoma peritonei (PMP), it is even more difficult. Cy...
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| Format: | Article |
| Language: | English |
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BMC
2018-09-01
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| Series: | World Journal of Surgical Oncology |
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| Online Access: | http://link.springer.com/article/10.1186/s12957-018-1482-7 |
| _version_ | 1819048500701167616 |
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| author | Ebbe Billmann Thorgersen Espen Melum Trine Folseraas Stein Gunnar Larsen Pål Dag Line |
| author_facet | Ebbe Billmann Thorgersen Espen Melum Trine Folseraas Stein Gunnar Larsen Pål Dag Line |
| author_sort | Ebbe Billmann Thorgersen |
| collection | DOAJ |
| description | Abstract Background Diagnostic work-ups in transplanted immunosuppressed patients are a challenge as non-specific findings may be interpreted as transplant-related complications. If the disease in question is rare and slowly developing like pseudomyxoma peritonei (PMP), it is even more difficult. Cytoreductive surgery (CRS) and subsequent hyperthermic intraperitoneal chemotherapy (HIPEC) is the recommended treatment for PMP even with extensive peritoneal spread. CRS-HIPEC for PMP after liver transplantation (LTX) has not been described before. Case presentation A 48-year-old female patient with end-stage primary sclerosing cholangitis (PSC) underwent orthotopic LTX and subsequent pancreaticoduodenectomy after the finding of cholangiocarcinoma in situ in the native common bile duct. Ten years after the transplantation, she developed symptoms and signs suspected to represent graft-related complications. An extensive work-up revealed PMP. Upon reassessment, a cystic mass near the coecum could be seen on computed tomography scan 1 year after transplantation. The multidisiplinary team was hesitant to accept the patient for CRS-HIPEC because of extensive PMP and possible risk to the graft. However, she was eventually accepted and underwent the procedure. The Peritoneal Cancer Index (PCI) was 28 of 39, and surgical debulking was performed followed by HIPEC. The transplant control 2 months after surgery showed no harm to the graft. Conclusions Previous LTX should not exclude the possibility for CRS-HIPEC in PMP, even with extensive burden of disease. |
| first_indexed | 2024-12-21T11:17:15Z |
| format | Article |
| id | doaj.art-cc79d0db703a44699e6736b84bca38cb |
| institution | Directory Open Access Journal |
| issn | 1477-7819 |
| language | English |
| last_indexed | 2024-12-21T11:17:15Z |
| publishDate | 2018-09-01 |
| publisher | BMC |
| record_format | Article |
| series | World Journal of Surgical Oncology |
| spelling | doaj.art-cc79d0db703a44699e6736b84bca38cb2022-12-21T19:05:54ZengBMCWorld Journal of Surgical Oncology1477-78192018-09-011611510.1186/s12957-018-1482-7Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for pseudomyxoma peritonei in a liver-transplanted patient: a case reportEbbe Billmann Thorgersen0Espen Melum1Trine Folseraas2Stein Gunnar Larsen3Pål Dag Line4Department of Gastroenterological Surgery, Division of Surgery, Inflammatory Diseases and Transplantation, The Norwegian Radium Hospital Oslo University HospitalNorwegian Primary Sclerosing Cholangitis Research Center, Department of Transplantation Medicine, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital RikshospitaletNorwegian Primary Sclerosing Cholangitis Research Center, Department of Transplantation Medicine, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital RikshospitaletDepartment of Gastroenterological Surgery, Division of Surgery, Inflammatory Diseases and Transplantation, The Norwegian Radium Hospital Oslo University HospitalInstitute of Clinical Medicine, University of OsloAbstract Background Diagnostic work-ups in transplanted immunosuppressed patients are a challenge as non-specific findings may be interpreted as transplant-related complications. If the disease in question is rare and slowly developing like pseudomyxoma peritonei (PMP), it is even more difficult. Cytoreductive surgery (CRS) and subsequent hyperthermic intraperitoneal chemotherapy (HIPEC) is the recommended treatment for PMP even with extensive peritoneal spread. CRS-HIPEC for PMP after liver transplantation (LTX) has not been described before. Case presentation A 48-year-old female patient with end-stage primary sclerosing cholangitis (PSC) underwent orthotopic LTX and subsequent pancreaticoduodenectomy after the finding of cholangiocarcinoma in situ in the native common bile duct. Ten years after the transplantation, she developed symptoms and signs suspected to represent graft-related complications. An extensive work-up revealed PMP. Upon reassessment, a cystic mass near the coecum could be seen on computed tomography scan 1 year after transplantation. The multidisiplinary team was hesitant to accept the patient for CRS-HIPEC because of extensive PMP and possible risk to the graft. However, she was eventually accepted and underwent the procedure. The Peritoneal Cancer Index (PCI) was 28 of 39, and surgical debulking was performed followed by HIPEC. The transplant control 2 months after surgery showed no harm to the graft. Conclusions Previous LTX should not exclude the possibility for CRS-HIPEC in PMP, even with extensive burden of disease.http://link.springer.com/article/10.1186/s12957-018-1482-7Cytoreductive surgeryHyperthermic intraperitoneal chemotherapyLiver transplantationPrimary sclerosing cholangitisPseudomyxoma peritonei |
| spellingShingle | Ebbe Billmann Thorgersen Espen Melum Trine Folseraas Stein Gunnar Larsen Pål Dag Line Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for pseudomyxoma peritonei in a liver-transplanted patient: a case report World Journal of Surgical Oncology Cytoreductive surgery Hyperthermic intraperitoneal chemotherapy Liver transplantation Primary sclerosing cholangitis Pseudomyxoma peritonei |
| title | Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for pseudomyxoma peritonei in a liver-transplanted patient: a case report |
| title_full | Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for pseudomyxoma peritonei in a liver-transplanted patient: a case report |
| title_fullStr | Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for pseudomyxoma peritonei in a liver-transplanted patient: a case report |
| title_full_unstemmed | Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for pseudomyxoma peritonei in a liver-transplanted patient: a case report |
| title_short | Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for pseudomyxoma peritonei in a liver-transplanted patient: a case report |
| title_sort | cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for pseudomyxoma peritonei in a liver transplanted patient a case report |
| topic | Cytoreductive surgery Hyperthermic intraperitoneal chemotherapy Liver transplantation Primary sclerosing cholangitis Pseudomyxoma peritonei |
| url | http://link.springer.com/article/10.1186/s12957-018-1482-7 |
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