Liver metastasectomy-cytoreductive surgery- hyperthermic intraperitoneal chemotherapy and ileal pouch-anal anastomosis: A case report

• Published in: International journal of surgery case reports 2020-01, Vol.72, p.397-401
• Main Authors: Chardalias, Leonidas, Gklavas, Antonios, Sotirova, Ira, Vlachou, Erasmia, Kontis, John, Papaconstantinou, Ioannis
• Format: Article
• Language: English
• Subjects: Case report; Familial adenomatous polyposis; Hyperthermic intraperitoneal chemotherapy; J-Pouch; Liver metastases; Peritoneal carcinomatosis
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2020.06.055

•Peritoneal carcinomatosis with concurrent liver metastases should not be treated as end stage disease.•IPAA anastomosis can be applied simultaneously with HIPEC, improving quality of life especially for Familial Adenomatosis Polyposis patients.•HIPEC as a prognostic factor of anastomotic healing; ileorectal anastomosis.•Liver metastasectomy with cytoreductive surgery and HIPEC may prolong survival. Cytoreductive surgery (CRS) with hyperthermal intraperitoneal chemotherapy (HIPEC) are established treatments for peritoneal carcinomatosis that prolong survival in carefully selected patients. At the time of diagnosis, 4–7% of patients with colorectal cancer (CRC) have metastasis to the peritoneum. There is a lack of evidence in the literature if J-pouch can be applied simultaneously with HIPEC to improve quality of life in patients with familial adenomatous polyposis syndrome (FAP) and peritoneal carcinomatosis. We describe a case of a 41-year-old Caucasian male with Familial Adenomatous Polyposis which was diagnosed as metastatic colorectal cancer in the liver and peritoneum. He was treated with systemic chemotherapy followed by total proctocolectomy with a J-shaped IPAA, liver metastasectomy, right hemidiaphragm resection, CRS and HIPEC. CRS and HIPEC have been implicated with high morbidity and mortality rates. A major independent risk factor correlated with high morbidity is anastomotic failure. J-Pouch formation although considered a technique with high complication rates, improves the quality of life of patients after total proctocolectomy and is related to high patient satisfaction. There are inconclusive data on whether anastomotic failure rates are higher when performing J-Pouch and HIPEC together. J-Pouch after CRS and HIPEC can be offered as a treatment as long as the patient is carefully selected, in high volume centers with experienced surgeons.