Cytoreductive surgery and perioperative intraperitoneal chemotherapy for peritoneal carcinomatosis from small bowel adenocarcinoma

Background: Small bowel adenocarcinoma is a rare malignancy that presents both a diagnostic and therapeutic challenge. The late presentation is often associated with disseminated carcinomatosis which is regarded a terminal event. We review our experience with small bowel peritoneal carcinomatosis following treatment with cytoreductive surgery (CRS) and perioperative intraperitoneal chemotherapy (PIC). Methods: From a prospective database of CRS and PIC, seven patients were identified to have undergone treatment for small bowel peritoneal carcinomatosis with CRS and hyperthermic intraperitoneal chemotherapy (Mitomycin C) and early postoperative intraperitoneal chemotherapy (5FU). A retrospective review was undertaken to describe the clinicopathological characteristics and survival outcomes. Results: The median follow-up was 17 months (range, 5-46 months). Six of sevenpatients have died. The disease-free survivalwas 12 months and the overall median survival was 25 months. The 1-, 2-, and 3-year survivals were 57%, 38%, and 20% respectively. Tumor histology of poorly differentiated adenocarcinoma with signet ring, lymphovascular invasion and perineural invasion appeared to be associated with a poor outcome. Conclusion: Cytoreductive surgery and perioperative intraperitoneal chemotherapy is a treatment option for small bowel cancer peritoneal carcinomatosis with encouraging survival results.