title: [Cytoreductive Surgery Performed Twice for Pseudomyxoma Peritonei with Pleural Extension of Mucinous Tumor].
abstract: Pseudomyxoma peritonei (PMP) is a condition characterized by production of a large amount of mucopolysaccharides by neoplastic epithelium, with intraabdominal cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) known to be viable treatment options. Pleural extension from an PMP is unusual and thought to be related to diaphragmatic perforation during surgery or transdiaphragmatic spreading of the disease through the lymphatic lacunae. Here, we report a patient with PMP with pleural extension of a mucinous tumor for whom CRS was performed twice. A 57-year-old female with PMP infiltrating the right chest cavity was scheduled for two separate CRS and hyperthermic chemotherapy procedures, because of the highly invasive characteristics of the surgery. For the first operation, we performed intra-abdominal surgery under general anesthesia combined with epidural anesthesia. To assess fluid and blood transfusion responsiveness, and reactions to vasoactive medication, we utilized an arterial pressure-based cardiac output monitor and central venous oximetry catheter. The second operation was performed 5 months later under general anesthesia with differential lung ventilation combined with epidural anesthesia. The operation and anesthesia for both surgical procedures were uneventful.
authors.forename: Taishin
authors.initials: T
authors.lastname: Ito
authors.forename: Fumiyo
authors.initials: F
authors.lastname: Yasuma
authors.forename: Yousuke
authors.initials: Y
authors.lastname: Toyonaga
authors.forename: Yoko
authors.initials: Y
authors.lastname: Kobayashi
authors.forename: Aki
authors.initials: A
authors.lastname: Shinohara
authors.forename: Mika
authors.initials: M
authors.lastname: Furuya
authors.forename: Yuka
authors.initials: Y
authors.lastname: Shiga
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Maehara
mesh_terms: D000768:Anesthesia, General; D065426:Cytoreduction Surgical Procedures; D003964:Diaphragm; D005260:Female; D006801:Humans; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010994:Pleura / Q000473:pathology* / Q000601:surgery*; D011553:Pseudomyxoma Peritonei / Q000188:drug therapy / Q000601:surgery*; D035423:Thoracic Cavity