Application of advanced multimodality care to pseudomyxoma peritonei patient: report of first patient treated at a tertiary center.

Pseudomyxoma peritonei following dissemination of appendicealmucinous neoplasms is slowly progressive but inevitably a lethal condition. It is locally invasive and does not lead to lymph node or distant metastasis making it amenable for more radical procedures. We present a case of pseudomyxoma peritonei treated by Cytoreductive surgery(CRS)and heated intraperitoneal chemotherapy(HIPEC) with Mitomycin C (12.5mg/m2 ) at 41.50 C. This was followed by five cycles of early postoperative intraperitoneal chemotherapy (EPIC) with 5FU (650 mg/m2) over 5 days. Patient underwent standard Peritonectomy procedure combined with resection of gallbladder, Spleen, subtotal colectomy and resection of part of small bowel. Blood loss during theprocedure was 4000ml. Histopathology revealed Pseudomyxoma peritonei (hybrid type). The patient recuperated well and was discharged and now is living a productive life. Peritonectomy with perioperative intraperitoneal chemotherapy is the current standard of treatment for appendiceal tumors with peritoneal dissemination which offers a hope of disease free long survival in such patients.

Neoadjuvant therapy and anastomotic leak after tumor-specific mesorectal excision for rectal cancer.

PURPOSE: This study was designed to evaluate whether neoadjuvant therapy is a risk factor for anastomotic leakage after rectal cancer surgery. METHODS: A retrospective review of 220 patients who underwent tumor-specific mesorectal excision for rectal cancer from 2000 to 2005 was performed. Risk factors for leak were identified by using a multivariable regression model. RESULTS: A total of 54 patients received neoadjuvant chemoradiation therapy and surgery, whereas 166 received surgery alone. No difference in clinically significant leaks was observed between the two groups (5.6 vs. 6.6 percent, P = 1). A diverting ileostomy was performed in 26.4 percent of patients who received neoadjuvant therapy compared with 9.7 percent for surgery alone (P = 0.0021). Neoadjuvant patients were more likely to have ultralow anastomoses (17.6 vs. 2.5 percent, P < 0.0001). On multivariate analysis, smoking (odds ratio, 6.37 (1.8, 22.2), P = 0.004), difficult anastomosis (odds ratio, 7.66 (1.8, 31.5), P = 0.0048), and low level of anastomosis (