[A Case of Successful Multidisciplinary Management of Recurrent Peritoneal Dissemination after Surgery for Sigmoid...

A 58-year-old male patient underwent laparoscopic-assisted high anterior resection and D3 dissection for sigmoid colon cancer in April 2017. Pathology results showed S, type 2, tub1, pSS, pN1, ly1, v0, pStage Ⅲa. He was treated with S-1 for 6 months as adjuvant chemotherapy. One year after surgery, PET-CT showed a peritoneal seeding nodule localized in the pelvis, and he underwent laparoscopic partial omentectomy and partial resection of the small intestine. Subsequently, a total of 35 courses of FOLFOX+Pmab therapy were performed. During this period, there was no apparent recurrence on imaging, but skin disorder appeared. So he was switched to S-1. During this period, CEA showed a gradual increase, and a PET-CT in February 2022 showed a single peritoneal seeding recurrence in the pelvis, and a laparoscopic resection of the tumor was performed in March of the same year. After the surgery, he underwent another 7 courses of S-1 at his strong wish. In October of the same year, PET-CT showed multiple peritoneal seeding nodules, and he underwent a total of 7 courses of FOLFOX+Pmab therapy. In June 2023, the skin disorder worsened again, and he was switched to FOLFIRI and received 1 course. However, at the patient's strong wish, he underwent immunotherapy and radiotherapy at another hospital. In October of the same year, he came back to our hospital and started FTD/TPI+Bmab because of increased CEA and increased peritoneal nodules. Although his CEA was gradually decreasing, he underwent laparoscopic small bowel bypass surgery in October 2024 due to the appearance of intestinal obstruction caused by peritoneal seeding nodules after 10 courses of FTD/TPI+Bmab. After the surgery, FTD/TPI+Bmab was resumed. He is now in a state of stable disease 8 years after the initial surgery(7 years after the recurrence of peritoneal dissemination).