원발성 복막암의 임상적 고찰

Abstract

Objective: To perform a retrospective analysis of the characteristics, the treatment modalities and the prognosis of primary peritoneal carcinoma.

Method: From January 2003 to June 2004, 5 patients with primary peritoneal carcinoma at the Department of Obstetrics and Gynecology, Yonsei University Medical Center were retrospectively reviewed for their demographic factors, past histories, presurgical assessments, types of surgery, the tumor markers, and types of adjuvant therapy employed.

Results: The group consisted of 5 cases of primary papillary serous carcinoma of the peritoneum. The median age at diagnosis was 59 years. All patients were postmenopausal with a median menopausal period of 9.8 years. 1 patient had a history of total abdominal hysterectomy with bilateral salpingo-oophorectomy. All patients had ascites and the abdominal distension was the most common presenting symptom. None of the patients presented with palpable pelvic mass on physical examination nor pelvic examination. All patients underwent gastrointestinal studies including 4 patients with abdomino-pelvic computed tomograpic scans, 2 patients with abdomino-pelvic magnetic resonance imaging studies, 3 patients with positron emission tomography. The magnetic resonance imaging findings were compatible with primary peritoneal carcinoma. The serum CA 125 levels of all 5 patients were elevated with median of 1421.6 U/ml. The serum CA 15-3 levels were also evaluated in 4 patients with median of 190 U/ml. All patients underwent surgery except 1 patient with a history of total abdominal hysterectomy with bilateral salpingo-oophorectomy. Diagnostic laparoscopy with multiple peritoneal seeding biopsies was performed with this patient. Neoadjuvant chemotherapy was performed in 2 patients and postoperative adjuvant chemotherapy was given to all 5 patients. All 5 patients are alive with the follow-up period ranging from 2-15 months.

Conclusion: Presurgical diagnosis of primary peritoneal carcinoma is very difficult although magnetic resonance imaging findings may be helpful. Aggressive treatment including maximal cytoreductive surgery with neoadjuvant and/or postoperative adjuvant chemotherapy is recommended for better prognosis of the disease.