Impact of laparoscopic surgery on survival of patients with small bowel adenocarcinoma and peritoneal metastasis.

The feasibility of laparoscopic surgery for peritoneal metastasis is still controversial. A 42-year-old male presenting with bloody stool underwent small intestinal fiberscopic examination. The biopsied specimens pathologically demonstrated adenocarcinoma of the upper jejunum. Laparoscopy revealed a 10-mm nodule in the omentum. Laparoscopic partial jejunal resection with regional lymph node dissection was performed with combined resection of the nodule without conversion. No other tumor was detected. The resected specimen contained an irregular ulcerative tumor measuring 52 x 33 mm. Microscopic examination revealed that the mass and peritoneal nodule comprised moderately differentiated adenocarcinoma. After surgery, the patient was treated with leucovorin/bolus and infusional 5-fluorouracil/oxaliplatin for 6 months. Eleven months after surgery, a solitary peritoneal recurrence developed near the camera port site. Six months later, positron emission tomography, computer tomography, and exploratory laparotomy revealed multiple peritoneal recurrences. The patient was then treated with leucovorin/bolus and infusional 5-fluorouracil/irinotecan. Three months and 6 months later partial remission and complete response, respectively were sequentially induced. The patient is alive 3 years and 9 months after initial surgery without any tumor recurrence. To our knowledge, this is the first report to demonstrate laparoscopic surgery combined with chemotherapy regimens, which induced a successful complete response.