Case Report
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 21, 2018; 24(19): 2130-2136
Published online May 21, 2018. doi: 10.3748/wjg.v24.i19.2130
Pressurized intraperitoneal aerosol chemotheprapy after misdiagnosed gastric cancer: Case report and review of the literature
Maciej Nowacki, Dariusz Grzanka, Wojciech Zegarski
Maciej Nowacki, Wojciech Zegarski, Department of Surgical Oncology, Ludwik Rydygier’s Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Oncology Centre-Prof. Franciszek Łukaszczyk Memorial Hospital in Bydgoszcz, Bydgoszcz 85-796, Poland
Dariusz Grzanka, Department of Clinical Pathomorphology, Ludwik Rydygier’s Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Bydgoszcz 85-094, Poland
Author contributions: Nowacki M designed the report and wrote the paper; Nowacki M and Zegarski W collected the patient’s clinical data, analyzed the data; Zegarski W reviewed the article; Grzanka D performed the histopatological analyses.
Informed consent statement: Written informed consent from patient involved in this study was received prior to study inclusion. All details that might disclose the identity of the subjects under study were omitted or anonymized.
Conflict-of-interest statement: Authors declare no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Maciej Nowacki, MD, MSc, PhD, Doctor, Lecturer, Research Scientist, Surgical Oncologist, Department of Surgical Oncology, Ludwik Rydygier’s Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Oncology Centre-Prof. Franciszek Łukaszczyk Memorial Hospital in Bydgoszcz, ul. Romanowskiej 2, Bydgoszcz 85-796, Poland. maciej.nowacki@cm.umk.pl
Telephone: +48-52-3743420 Fax: +48-52-3743412
Received: January 30, 2018
Peer-review started: January 31, 2018
First decision: February 24, 2018
Revised: March 22, 2018
Accepted: March 31, 2018
Article in press: March 31, 2018
Published online: May 21, 2018
Abstract

We report the first application of pressurized intraperitoneal aerosol chemotherapy (PIPAC) as a rescue therapy before palliative D2 gastrectomy combined with liver metastasectomy performed in a 49-year-old woman with peritoneal carcinomatosis who was primarily diagnosed with and underwent surgery for a Krukenberg tumor. The PIPAC procedure was performed with the use of cisplatin at 7.5 mg/m2 and doxorubicin at 1.5 mg/m2 for 30 min at 37 °C. Eight weeks after the PIPAC procedure, the patient underwent open classic D2 gastrectomy with the creation of a Roux-en-Y anastomosis (RNY) combined with liver metastasectomy. The patient underwent the classic protocol for chemotherapy combined with Xeloda. The patient felt better and returned to her daily activities. Multicenter data should be gathered to confirm the usefulness of PIPAC as a rescue or neoadjuvant supportive therapy in a very select group of patients who have been recently qualified to undergo classic chemotherapy or standard oncologic surgical procedures.

Keywords: Peritoneal carcinomatosis, Pressurized intraperitoneal aerosol chemotherapy, Neoadjuvant therapy, Gastric cancer, Krukenberg tumor

Core tip: The Krukenberg tumor (KT) is very often misdiagnosed as primary ovarian cancer and may be occasionally diagnosed during a clinical work-up. The fast implementation of effective treatment is always necessary. This case might contribute to future confirmation of the usefulness of pressurized intraperitoneal aerosol chemotherapy as a rescue or neoadjuvant, supportive form of therapy in a very select group of patients. This clinical development might be particularly important for patients with a KT presentation of gastric cancer who have been recently qualified to undergo classic chemotherapy or standard oncologic surgical procedures.