Very important data from recent clinical studies have proven that peritoneal carcinomatosis can be effectively treated, giving hope to patients who until now only sought palliative treatment.

The French study PRODIGE 7 showed a threefold increase in survival compared to earlier treatment protocols in patients with colon cancer and extension to the peritoneum. From Spain, a phase III study also showed a significant increase in the length of time patients with colon cancer and peritoneal extension are cancer-free. Now, in the official guidelines of the American Society of Pathologists-Oncologists (ASCO), cytoreductive surgery is recommended in selected cases of patients with peritoneal carcinomatosis from colon cancer.

But what is peritoneal carcinomatosis?

Imagine a person’s abdomen and bowels as a room with its furniture. Now imagine that everything is covered by a thin sheet. This is the peritoneum and when cancer escapes the confines of a viscera it can spread to the surface of the peritoneum in small masses called ‘implantations or peritoneal metastases’. This condition called “peritoneal carcinomatosis” was for many decades an indication of the final stage of the disease and without hope of cure.
Today after many years of clinical studies and with the progress of oncology, patients with peritoneal carcinomatosis are treated with greater optimism. The good results arise, mainly because we can correctly select the patients who will be taken to the operating room and also to the progression of the cytoreductive surgery.

What is cytoreductive surgery?

Cytoreductive surgery can free the patient from the burden of cancer and in combination with systemic chemotherapy, give them time, quality of life and even a cure. It is a combination of surgical techniques that lead to the eradication of all cancer foci present in the peritoneum. Cytoreductive surgery requires special training, dedication and experience from the entire surgical and anesthetic team and is always performed after consultation with a pathologist-oncologist.

Is cytoreductive surgery dangerous?

Cytoreduction is indeed a major surgery but it is not a dangerous surgery. Cancer is dangerous, not its treatment. Teams with well-trained and stable members in tertiary care hospitals have proven to be able to complete operations with little chance of post-operative problems and ensuring a good patient course.

Which patient is a candidate for this treatment?

The types of cancer that most often show the phenomenon of peritoneal carcinomatosis are cancer of the appendix (pseudomyxoma), colon cancer, peritoneal mesothelioma, and ovarian cancer. A condition for the application of cytoreduction is that the cancer concerns only the peritoneum, without multiple metastases in the liver or lungs. When decided by the oncology board, and after careful assessment of the patient’s condition, we recommend the solution of cytoreduction often accompanied by Hyperthermic Intraperitoneal Chemotherapy (HIPEC). With HIPEC, through a special circulator, the abdomen is washed with chemotherapy drugs at a high temperature. This complementary treatment aims to destroy cancer cells that remain in contact with the viscera.

How is the pre-operative assessment of the patient done?

Before any treatment decision is made, proper staging of the patient is required. Staging is the recording with modern imaging techniques of the extent of the cancer, but also the attempt to understand its biological behavior. Staging includes CT and MRI scans, PET scan and very often diagnostic laparoscopy. Diagnostic laparoscopy is performed as a day surgery and is valuable in assessing the extent of cancer in the peritoneum. It allows biopsies to be obtained that provide important information and thus the patient’s treatment protocol can be determined. Diagnostic laparoscopy can expedite definitive surgery or lead the patient first to chemotherapy and then to surgery. The final decision will be made by the oncology board.

When does chemotherapy precede cytoreduction?

Very often, the treatment protocol calls for the administration of chemotherapy before cytoreductive surgery. This is done so that the patient arrives at the surgery in the best possible conditions, but also to give time to assess the biological behavior of the cancer. Thus, we have the sequence of chemotherapy – surgery – chemotherapy aiming at the final cure.

What should the patient with peritoneal carcinomatosis expect?

Patients faced with a diagnosis of advanced cancer have to deal with some immediate changes in their lives. The way to succeed is to offer them the greatest possible support from doctors and nurses, the health system and their close environment. The surgical and nursing team of MITERA offers high-level medical and nursing services and stands by the patient during the difficult period of treatment.

Cytoreductive surgery combined with intraperitoneal chemotherapy (HIPEC) is offered at MITERA by the team of surgeon Mr. Stamos who has the training, experience and all the necessary equipment for these demanding operations.