title: Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Dissemination from Small Bowel Malignancy: Results from a Single Specialized Center.
abstract: BACKGROUND
  Peritoneal dissemination is a frequent pattern of recurrence and metastasis of small bowel malignancy (SBM). However, the survival of patients with peritoneal dissemination from SBM is not clear, and there is no consensus on the treatment for it.
  
  
  METHODS
  A total of 31 selected patients with peritoneal dissemination from SBM were treated by cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) between January 2006 and January 2014. The major focus of this study was overall survival, as well as morbidity and mortality.
  
  
  RESULTS
  Twenty-five patients had small bowel adenocarcinoma (SBA), and six patients had non-adenocarcinoma SBM. HIPEC was performed on 21 patients, and 21 patients received complete cytoreduction. There was no treatment-related mortality, and eight (25.8 %) patients had grade 3-4 complications. Until the latest follow-up, the median survival of 31 patients after CRS and HIPEC was 36 months (range 5-95 months), and the median survival after diagnosis was 51 months (range 18-101 months). For 25 patients with peritoneal carcinomatosis from SBA, the median survival after CRS and HIPEC was 36 months (range 6-95 months), and the median survival after diagnosis was 50 months (range 18-101 months). Multivariate analysis revealed that peritoneal cancer index <15 (p = 0.009) and HIPEC (p < 0.001) were independent predictors of better survival in patients with peritoneal dissemination from SBM treated by CRS and HIPEC.
  
  
  CONCLUSIONS
  Until more data become available, a reasonable strategy for the treatment of SBM is CRS and HIPEC. It can be applied with acceptable safety in selected patients with peritoneal dissemination from SBM.
authors.affiliation: NPO to Support Peritoneal Surface Malignancy Treatment, Kyoto, Osaka, Japan. lymikeleo@hotmail.com.|Peritoneal Dissemination Center, Kishiwada Tokushukai Hospital, Kishiwada, Japan. lymikeleo@hotmail.com.
authors.forename: Yang
authors.initials: Y
authors.lastname: Liu
authors.affiliation: NPO to Support Peritoneal Surface Malignancy Treatment, Kyoto, Osaka, Japan.|Peritoneal Dissemination Center, Kishiwada Tokushukai Hospital, Kishiwada, Japan.
authors.forename: Haruaki
authors.initials: H
authors.lastname: Ishibashi
authors.affiliation: NPO to Support Peritoneal Surface Malignancy Treatment, Kyoto, Osaka, Japan.|Peritoneal Dissemination Center, Kishiwada Tokushukai Hospital, Kishiwada, Japan.
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Takeshita
authors.affiliation: Department of Surgery, Kusatsu General Hospital, Kusatsu, Shiga, Japan.
authors.forename: Akiyoshi
authors.initials: A
authors.lastname: Mizumoto
authors.affiliation: Department of Surgery, Kusatsu General Hospital, Kusatsu, Shiga, Japan.
authors.forename: Masamitsu
authors.initials: M
authors.lastname: Hirano
authors.affiliation: NPO to Support Peritoneal Surface Malignancy Treatment, Kyoto, Osaka, Japan.
authors.forename: Shouzou
authors.initials: S
authors.lastname: Sako
authors.affiliation: NPO to Support Peritoneal Surface Malignancy Treatment, Kyoto, Osaka, Japan.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Takegawa
authors.affiliation: Department of Surgery, Kusatsu General Hospital, Kusatsu, Shiga, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Takao
authors.affiliation: Department of Surgery, Kusatsu General Hospital, Kusatsu, Shiga, Japan.
authors.forename: Masumi
authors.initials: M
authors.lastname: Ichinose
authors.affiliation: NPO to Support Peritoneal Surface Malignancy Treatment, Kyoto, Osaka, Japan. y.yonemura@coda.ocn.ne.jp.|Peritoneal Dissemination Center, Kishiwada Tokushukai Hospital, Kishiwada, Japan. y.yonemura@coda.ocn.ne.jp.|Department of Surgery, Kusatsu General Hospital, Kusatsu, Shiga, Japan. y.yonemura@coda.ocn.ne.jp.|, Kyoto, Japan. y.yonemura@coda.ocn.ne.jp.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Yonemura
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D010478:Chemotherapy, Cancer, Regional Perfusion; D003131:Combined Modality Therapy; D065426:Cytoreduction Surgical Procedures; D004379:Duodenal Neoplasms / Q000473:pathology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006979:Hyperthermia, Induced; D007421:Intestine, Small / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000628:therapy; D009367:Neoplasm Staging; D010534:Peritoneal Neoplasms / Q000556:secondary / Q000628:therapy*; D011379:Prognosis; D013274:Stomach Neoplasms / Q000473:pathology / Q000628:therapy*; D015996:Survival Rate; D055815:Young Adult