Peritoneal surgery

Peritoneal surgery or omentum surgery are options to treat advanced cancers situated in the abdomen. Hyperthermic intraperitoneal chemoperfusion is a highly specialised method which combines removal of the peritoneum with chemotherapy.

Peritoneal cancer or omentum cancer are almost solely caused by metastasised tumours of the abdominal or pelvic organs. Thus, if the peritoneum is affected, this is usually a sign that the cancer is already advanced.. Removal of the peritoneum (peritonectomy) or the omentum (omentectomy) in patients with cancer can prevent problems such as abdominal dropsy and increase their life expectancy. This applies in particular for the combination of a peritonectomy and abdominal irrigation with chemotherapeutic drugs which has been used for a few years. This method is known as hyperthermic intraperitoneal chemoperfusion (HIPEC).

What preparations are carried out before the procedure?

The decision to undertake surgery in the event of cancer of the peritoneum is taken by an interdisciplinary team. This tumour board, consisting of different specialists, decides whether surgery is sensible and possible based on the stage of the disease and after weighing up the risks and the advantages.

It often only becomes apparent after opening the abdomen whether the peritonectomy or omentectomy and irrigation with medication can actually take place.

All the usual pre-operative assessments are required, such as a blood test, blood pressure measurement and an ECG. The examination takes place under general anaesthetic. Patients must have an empty stomach for the procedure.

How is the operation carried out?

Hyperthermic intraperitoneal chemoperfusion, HIPEC

After opening the abdomen, it becomes evident whether the metastases in the peritoneum can be surgically removed. If this is the case, depending on the situation, part or the entire peritoneum is removed (peritonectomy). Afterwards, the abdomen is irrigated with a hyperthermic chemotherapy solution. The irrigation solution, which contains anti-cancer medication, is warmed to 42° C. Warming the irrigation solution increases the effectiveness of the treatment on the cancer cells. Irrigation provides an approx. 30 x higher concentration of medication in the abdomen than standard chemotherapy with tablets or injections.  The irrigation usually takes one to two hours; however, in exceptional cases, it can also take several hours. The patient is under sedation the entire time.

Omentectomy

The omentum is surrounded by the peritoneum and covers the abdominal organs. It contains fat tissue, blood vessels and immune cells. The omentum may need to be removed when it is affected by cancer cells or in rarer cases by peritonitis. The surgery is performed on the open abdomen. The blood vessels running through the omentum are tied off. Then the omentum is exposed and removed.

What is the success rate of this procedure?

The prognosis after the surgery on the peritoneum or on the omentum due to cancer depends on the stage of the cancer in question. The cancer is usually in an advanced stage. The procedure minimises complications such as abdominal dropsy (ascites) and often increases the patient's life expectancy by several months. There are also known cases where patients have lived for more than five years after undergoing the procedure.

What are the possible complications and risks of this procedure?

Hyperthermic intraperitoneal chemoperfusion places considerable stress on the body. The procedure is also connected with increased risks of complications such as wound healing disorders and infections. The decision to undergo surgery must be made carefully while weighing up the risks and the advantages.

What happens after the operation?

After the surgery, the patient is monitored and cared for in ICU.  They are usually transferred to the wards a day later. The follow-up treatment and care is based on the type and stage of the primary cancer.

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