Surgery for Peritoneal Cancer
The term ‘peritoneum’ refers to the lining of the abdominal cavity. Cancer arising within abdominal organs such as the appendix, bowel or ovaries may spread to involve the peritoneum. Rarely, cancer may also develop within the peritoneum itself.
The treatment of patients with peritoneal cancer is highly specialised and involves a multidisciplinary team including surgeons, anaesthetists, oncologists, radiologists, pathologists, specialist nurses, dietitians, and physiotherapists. In 2013 the National Centre for the treatment of patients with cancer of the peritoneum was established at the Mater Hospital Dublin. Prior to that, patients from Ireland were treated by Mr Brendan Moran and his colleagues at the Peritoneal Malignancy Institute Basingstoke, UK. Mr Moran and his team have generously supported the development of the peritoneal malignancy treatment programme at the Mater Hospital.
The treatment of patients with peritoneal cancer may involve a complex operation known as cytoreductive surgery. Cytoreductive surgery is performed with the aim of removing all tumour involving the peritoneum and may require any, or all, of the following procedures:
- Peritonectomy – removal of the lining of the abdominal cavity
- Colectomy - removal of part or all of the large bowel (colon)
- Anterior resection – removal of the rectum
- Omentectomy – removal of the fatty apron covering the abdominal cavity
- Cholecystectomy – removal of the gallbladder
- Splenectomy – removal of the spleen
- Removal of tumour from the surface of the liver
- Gastrectomy – removal of part or all of the stomach
- In females, removal of the womb and ovaries
Immediately after the surgery, heated chemotherapy (HIPEC) is delivered into the abdominal cavity to remove any remaining microscopic (non-visible) cancer cells. The combined cytoreductive surgery and HIPEC procedure can take up to ten hours.
Cytoreductive surgery combined with HIPEC is a major operation and may not be the best treatment option for all patients with peritoneal cancer. The patients most likely to benefit from this approach are those with tumour of the appendix (including patients with a condition known as pseudomyxoma peritonei) or cancer of the large bowel (colorectal cancer) that has spread to involve the peritoneum.
Pseudomyxoma peritonei is a rare condition which typically occurs following rupture of a mucin producing tumour of the appendix. Mucin producing cells may spread to the peritoneum and produce large volumes of a jelly-like liquid. Untreated, swelling of the abdomen and compression of the abdominal organs may follow. Pseudomyxoma does not typically spread to organs outside the abdominal cavity.
In certain circumstances cytoreductive surgery and HIPEC may also be performed for rarer tumours such as abdominal mesothelioma (a tumour arising primarily in the peritoneum) and also for patients with cancer of the ovary, stomach or other organs that has spread to the peritoneum.
Typically patients will spend two weeks in hospital after the surgery, however the recovery period may vary from individual to individual. In certain circumstances, we may recommend further treatment after discharge in the form of (traditional) chemotherapy.