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An asymptomatic 78-year-old woman with anemia had undergone abdominal ultrasonography 6 years ago, which revealed a 7-cm hepatic tumor. The patient was regularly followed-up assuming that the tumor was a hepatic hemangioma with cyst. However, the tumor gradually increased in size. Abdominal CT and MRI revealed that the tumor comprised a mixture of cystic and solid components, and there was dilation of the bile duct. A clinical diagnosis of intraductal papillary neoplasm of the bile duct was made. Caudate and right hepatic lobectomy was performed. The pathological diagnosis of the tumor was a papillary adenocarcinoma. This case, in which the patient was followed for 6 years before curative surgical treatment, is significant, because it demonstrates the slow-growing nature of this tumor.

An aggressive approach to peritoneal dissemination involves peritonectomy procedures combined with preoperative intraperitoneal chemotherapy, intraoperative chemo-hyperthermia, and postoperative systemic chemotherapy. We have been performing multimodal therapy consisting of peritonectomy plus perioperative chemotherapy for the treatment of patients with peritoneal dissemination. Fifty-seven patients with established peritoneal dissemination from gastric cancer (n = 32), colon cancer (n = 17), ovarian cancer (n = 7), and mesothelioma (n = 1) have been treated with peritonectomy and intraoperative chemo-hyperthermia. Five-year survival rates of patients with gastric and colon cancer were 18% and 38%, respectively. Among various clinical factors, complete tumor resection was the most significant prognostic factor, and the prognosis of patients who underwent complete cytoreduction was significantly better than those who received incomplete cytoreduction. A multimodal therapy consisting of perioperative chemotherapy and peritonectomy with complete cytoreduction may be the most powerful method to treat patients with established peritoneal dissemination.