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Cytoreductive surgery is a comprehensive and meticulous type of surgery, in which we examine the entire abdomen inch by inch to remove all tumour nodules from the peritoneum. It involves a combination of peritonectomy (removal of the peritoneum) and other organs to remove all visible disease from the abdomen. This procedure can be performed via conventional open surgery or through a minimally invasive approach, by laparoscopy.
HIPEC stands for hyperthermal intraperitoneal chemotherapy. It is a treatment for patients with advanced cancer that has spread throughout the peritoneum. This treatment aims to kill the tumour and prolong the patient’s survival.
It consists of administering chemotherapy at a temperature between 40-43ºC for between 60-120 minutes at the end of the cytoreduction surgery procedure.
This procedure is completed with a dose of warm chemotherapy, administered as an infusion, which is removed from the abdomen at the end of the procedure. The goal is to eliminate microscopic disease, eliminating any tumour cells that may be loose in the abdomen after surgery with that dose of chemotherapy.
It is a curative treatment for patients with advanced cancer that has spread to the peritoneum. This is known as peritoneal carcinomatosis or peritoneal metastases.
The primary tumour may be located:
Stomach, colon, small intestine, ovary, pancreas, endometrium, appendix (one of its variants is peritoneal pseudomyxoma), cholangiocarcinoma.
Lung cancer, breast cancer, melanoma.
Peritoneal mesothelioma, primary peritoneal cancer.
The aim of cytoreductive surgery or peritonectomy and HIPEC is curative.
To explain which patients are candidates for this treatment we must first understand what PCI (peritoneal cancer index) means.
PCI is the amount of tumour inside the abdomen. It is an index that indicates the degree of disease, and which is very important for surgical oncologists, since it tells us a lot about the patient’s prognosis and the best treatment sequence for each individual.
It is a number between 0 and 39, calculated by dividing the abdomen into 12 regions and assigning a score of 0 to 3 according to the number of peritoneal implants and the size at that location.
Currently, treatments for peritoneal carcinomatosis remain limited and have a conservative prognosis.
Standard palliative chemotherapy often provides only modest improvement in prognosis with low tumour response rates. In addition, this treatment is associated with a significant risk of harmful side effects.
Multimodal management combining systemic chemotherapy, complete cytoreductive surgery, which can be combined with the administration of hot intraperitoneal chemotherapy (HIPEC), is an effective alternative for patients where spread of the disease is limited and does not affect areas known to be unresectable (for example when the disease has spread to a large area of the small intestine, the liver hilum…).
This surgery, with or without HIPEC, can be performed in our facility using conventional open surgery,
but for selected patients we also offer the possibility of performing this surgery through minimally invasive means (laparoscopy).
Depending on the origin of the primary tumour and the PCI, we can offer treatment with cytoreductive surgery and HIPEC in the following scenarios:
It depends on many factors, but usually between 7 and 20 days.
The first 24 – 48 hours are usually spent in the ICU for close monitoring, although the patient is awake, carrying out physical and respiratory rehabilitation exercises… and later on the ward, until they are in a fit state to return home, where they will continue with their postoperative recovery programme at home.
The performance of this surgery by expert teams and in accordance with a pre-operative prehabilitation and ERAS programme (early postoperative recovery) are important to reduce complications or their impact.
After this surgery, complications can appear from major abdominal surgery such as infection, bleeding, anastomotic leak, respiratory and urinary tract infections… and complications derived from chemotherapy (such as a drop in white blood cells, platelets, impaired renal function)…
At IVOQA, our protocols seek to reduce these complications and to detect them early.complicaciones, así como una detección precoz de las mismas.
This is a complex case but one we see frequently in our consultations. Unfortunately, in many facilities, these patients are offered palliative care only.
We have many years of experience treating patients with metastases in several sites, requiring a thorough study by the tumours committee.
We always begin with intravenous chemotherapy and, depending on how the cancer responds, we evaluate whether to take a radical approach to remove the whole disease in accordance with very strict parameters
All patients with peritoneal disease should be evaluated in a peritoneal surgery unit, by a committee of experts in peritoneal pathology, even patients with liver metastases, inoperable disease and high PCI, since we now have multiple treatment options for all of them
What about patients with a high PCI or unresectable disease and/or non-response, or disease progression despite systemic chemotherapy?
In these cases, PIPAC can be a great alternative
All patients with peritoneal disease should be evaluated in a peritoneal surgery unit, by a committee of experts in peritoneal pathology, even patients with liver metastases, inoperable disease and high PCI, since we now have multiple treatment options for all of them
What about patients with high PCI or with unresectable disease and/or non-response or disease progression despite systemic chemotherapy?
Contact
HOSPITAL UNIVERSITARIO VIAMED SANTA ELENA
Phone: +34 617 025 602 (Attention for national and international patients).
Email: ivoqa@viamedsalud.com
C/La Granja, 8 28003 Madrid
Metro: Vicente Aleixandre (línea 6)
Guzmán el Bueno (línea 6 y 7)
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