title: Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for patients with peritoneal carcinomatosis secondary to urachal adenocarcinoma.
abstract: OBJECTIVE
  Urachal adenocarcinoma with peritoneal dissemination is an unusual presentation of a rare disease. It is associated with patients experiencing significant pain, poor outcomes, and historical median survival times between 12 and 24 months. We describe our 18-year experience in managing these patients with cytoreductive surgery (CRS) followed by hyperthermic intraperitoneal chemotherapy (HIPEC).
  
  
  METHODS
  Five patients who underwent six CRS with HIPEC for disseminated urachal cancer were identified. Demographics, perioperative data, and oncologic results were reviewed.
  
  
  RESULTS
  All patients successfully completed CRS followed by HIPEC with Mitomycin C. Three patients had prior urachal mass excision and one had previous cystoprostatectomy with ileal conduit. At time of surgery, complete resection of all visible disease was only achieved in two patients. All patients developed local or distant disease recurrence at a median of 13 months postoperatively (range 7-31). The majority of patients (3/5) underwent postoperative intravenous chemotherapy for recurrence (2) or residual disease (1). All patients died of their disease, with median survival following date of surgery of 27 months (range 21-87). Symptomatic control of peritoneal disease was achieved in 2/5 (40%) of the cases.
  
  
  CONCLUSIONS
  Urachal adenocarcinoma with peritoneal dissemination is an aggressive, rare disease, which is uniformly fatal. In our experience, CRS followed by HIPEC with Mitomycin C may increase patient survival and palliation, although further treatment improvements are clearly required.
authors.affiliation: Department of Urology, Wake Forest University, Winston Salem, North Carolina, USA.
authors.forename: L Spencer
authors.initials: LS
authors.lastname: Krane
authors.forename: A Karim
authors.initials: AK
authors.lastname: Kader
authors.forename: Edward A
authors.initials: EA
authors.lastname: Levine
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000556:secondary / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000903:Antibiotics, Antineoplastic / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D010478:Chemotherapy, Cancer, Regional Perfusion; D006801:Humans; D006979:Hyperthermia, Induced; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000627:therapeutic use; D009364:Neoplasm Recurrence, Local; D010534:Peritoneal Neoplasms / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology*; D055815:Young Adult
chemical_list: D000903:Antibiotics, Antineoplastic; D016685:Mitomycin