Hyperthermic intraperitoneal chemotherapy in management of malignant intraductal papillary mucinous neoplasm with peritoneal dissemination: Case report

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IPMN is not a common disease, has low risk to develop invasive lesion. But when invasion occurred, the prognosis is poor.

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Malignant IPMN with peritoneal dissemination also has poor prognosis.

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CRS and HIPEC can prolong survival in malignant IPMN with peritoneal dissemination patient.

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Pseudomyxoma peritonei can be found as rare manifestation of IPMN, that can associate with tumor rupture form diagnostic procedure like EUS-FNA or surgical procedure.

Introduction

Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are treatment to deal with peritoneal dissemination that has excellent result for various cancer especially pseudomyxoma peritonei (PMP), mesothelioma. For now, this combination of treatment is still running for pancreatic adenocarcinoma but no description for pancreatic cystic tumor like malignant Intraductal papillary mucinous neoplasm (IPMN).

Presentation of cases

We report 3 cases of malignant IPMN with peritoneal dissemination that treated with CRS and HIPEC. Two cases have atypical presentation of malignant IPMN with PMP. HIPEC was performed using cisplatin-based regimen. The longest survival in this study is 93 months, compared to the median survival of 44.3 months without HIPEC.

Discussion

CRS and HIPEC have not proven to treat in patient with pancreatic cystic tumor with peritoneal dissemination. But these treatments can be improved survival outcome in selected patient.

Conclusion

CRS and HIPEC trend to improve survival. More studies need, not only to evaluate the role of HIPEC on malignant IPMN, but also prognosis and outcome.

Current Status of Peritoneal Surface Malignancy in Thailand

Peritoneal dissemination negatively affects the survival of cancer patients. Comprehensive treatment comprising of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) introduced by Dr. Paul H. Sugarbaker in 1980 has shown a benefit in survival especially in patients with gastrointestinal cancer and ovarian cancer. Thailand started to perform this integrated treatment in 2012. A modification of the heart-lung machine was used as the hyperthermic pump for the first few years. Until now, 240 cases have been treated in 7 centers. Although the Thai health care system covers all areas and is easy to access, many surgeons still doubt the benefit and safety of this treatment. This coupled with difficulty in procuring the equipment, and high procedural cost has resulted in few surgeons offering this treatment and fewer patients availing of it. The small group of peritoneal surface malignancy (PSM) surgeons tries to educate all health care providers to understand how it works in an advanced-stage cancer patient and to make this procedure be covered by the national health care policy.