A 74-year-old male with diffuse gelatinous ascites underwent cytoreductive surgery including ileocecal resection and greater omentectomy. Pathology revealed mucinous adenocarcinoma with low-grade malignancy originating in the appendix with disseminated peritoneal adenomucinosis, which was diagnostic of pseudomyxoma peritonei. A subcutaneous reservoir was implanted intraoperatively for intraperitoneal chemotherapy initiated at the time of operation. The patient received intraperitoneal chemotherapy with weekly paclitaxel at a dose of 60 mg/m(2) for 3 weeks, followed by a 1-week rest, repeated every 4 weeks for 2 months. Subsequently, paclitaxel was given intravenously at the same dose every 2 weeks for 2 months, and then the patient was placed on oral S-1 at a dose of 100 mg/body/day, administered daily for 2 consecutive weeks, followed by a 1-week rest, repeated every 3 weeks for 9 months. The patient tolerated the chemotherapy well, developing grade 1 anemia and grade 2 neutropenia plus elevation of total bilirubin. Tumor markers, CEA and CA19-9, fell to the normal range postoperatively, and have remained stable so far. A follow-up computed tomography (CT) scan revealed small ascites only in the right pelvis 8 months later after the initial operation, and complete disappearance of ascites 17 months later. Two years later, the patient presented with ileus, and required adhesionlysis as well as partial resection of adhesive ileum. No evidence of recurrent disease was confirmed intraoperatively as a second look. To date, the patient has been free of recurrence.

Fujitani K, Ogawa H, Takeda M, Hirao M, Yasui M, Kashiwazaki M, Ikenaga M, Miyazaki M, Mishima H, Nakamori S, Manoh M, Tsujinaka T.

Dept. of Surgical Oncology, Osaka National Hospital.