Cytoreduction of the Small Bowel Surfaces

摘要

The combined treatment modality consisting of cytoreductive surgery and intraperitoneal chemotherapy has gained acceptance as a treatment option for management of peritoneal surface malignancies . This is particularly true for mucinous neoplasms that arise from the appendix or colon. Perhaps the most consistent benefit occurs in the treatment of pseudomyxoma peritonei syndrome . This disease is characterized by a long natural history and an extensive accumulation of mucinous ascites and tumor. Pseudomyxoma peritonei most commonly has a perforated neoplasm of the appendix as the primary site. The pattern of spread of the mucinous cancer cells within the peritoneal cavity is not random but is instead governed by gravity and resorption of the peritoneal fluid . The tumor deposits are characteristically found in large amounts in the areas where peritoneal fluid resorption occurs, the greater omentum and the undersurface of the right hemidiaphragm. Also, deposits tend to accumulate in dependent areas and recesses such as the retrohepatic space, the pouch of Douglas, the recess formed by the ligament of Treitz and the subpyloric space . Characteristically, the small bowel and its mesentery are relatively spared, due in large part to the continuous peristaltic movement of the intestines