Peritoneal Malignancy Surgery (Peritonectomy)

Procedure

Peritoneal Malignancy Surgery includes cytoreductive surgery (CRS) and may also include Hyperthermic Intraperitoneal Chemotherapy (HIPEC), which is used to treat cancers that involve the peritoneal lining of the abdomen. The peritoneum is a thin lining that covers the small and large bowel and internal organs of the abdomen as well as the inside of the abdominal wall.

There are certain cancers that either begin in, or spread to the peritoneum such as, appendiceal cancer, pseudomyxoma peritoneii, colorectal cancer, ovarian cancer, peritoneal mesothelioma and gastric cancer which can be treated with peritoneal malignancy surgery and HIPEC. Traditional chemotherapy given via tablets or intravenously is less effective when the tumour is on the surface of the abdominal wall and organs. This means that peritoneal disease can be more complex to treat. Peritoneal malignancy surgery and HIPEC has been around since the early 1980s and there is growing evidence that it can improve survival rates and quality of life in a select group of patients with cancers that have spread to the peritoneum.

CYTOREDUCTIVE SURGERY(CRS)
The first part of the peritoneal malignancy procedure is to perform cytoreductive surgery (CRS) which is the removal of all visible disease inside the abdominal cavity. The operation is usually performed through an open incision in the middle of the abdomen. When removing these tumours, it is sometimes necessary that other organs be partly or completely removed. This is only done if the tumour cannot be separated from the organ's surface. Organs that may need to be partly or completely removed include small or large bowel, omentum, spleen, stomach, gallbladder, bladder and female reproductive organs (ovaries, uterus, fallopian tubes). When part of the small or large bowel is removed sometimes there is a need for a stoma to be formed (colostomy/ileostomy) with bowel contents draining into a bag on the abdomen surface. Stomas may be temporary or permanent depending on the extent of surgery and your circumstances. The amount of surgery needed to remove all visible tumours, varies a lot between different patients and it depends on the extent of the disease.

HYPERTHERMIC INTRAPERITONEAL CHEMOTHERAPY (HIPEC)
The second part of the procedure is Hyperthermic Intraperitoneal Chemotherapy (HIPEC). After all the visible tumour has been removed, the abdominal cavity is treated with HIPEC, which aims to kill any remaining microscopic cancer cells. During the operation, HIPEC, a heated chemotherapy solution is delivered into the abdominal cavity for about 60 minutes. The chemotherapy agent used is dependent on the tumour type. The chemotherapy agent is administered by a HIPEC pump system managed by the surgical and nursing staff. Only a small amount of the chemotherapy is absorbed so higher doses can be used without the systemic side effects that can occur with traditional chemotherapy. The chemotherapy is heated to 42-43 degrees Celsius as this increases its effectiveness in destroying cancer cells.
Once complete, the chemotherapy agent is washed out of the abdominal cavity and the remainder of the operation is completed.

Indications:

• Colorectal cancer with peritoneal metastases
• Appendiceal cancer
• Pseudomyxoma peritoneii
• Ovarian cancer
• Peritoneal mesothelioma

** The indications and surgical management for each patient may differ. Please consult your surgeon for more information or any questions you may have

Clinical Staff

Colorectal Consultants
Dr Nabila Ansari
Associate Professor Cherry Koh
Dr Nima Ahmadi

Anaesthetists

Medical Oncologists

Intensive Care Physicians

Radiologists

Psychiatrists

Pain Specialist

Palliative Care

Stomal Therapy Nurses

Total Parenteral Nutrition Practitioner

Allied Health
Clinical Psychologist -
Dietitian -
Physiotherapist -
Social Worker -

Research Officer

Medical Team
Other Consultants
Surgical Fellows
Surgical Registrars
Interns

Nursing Team
Nurse Unit Manager (NUM)
Peritonectomy Clinical Nurse Consultant
Clinical Nurse Specialists (CNS)
Registered Nurses (RN)/ Enrolled Nurses (EN)
Operating Theatre Nurses
Intensive Care Unit Nurses

Research

The peritoneal malignancy program is currently undertaking research into the quality of life outcomes for all patients who have the procedure at RPA.

This study is called the PREMIER study with 14 sub studies currently running within this program.

The clinical team and researchers at RPA are also working with other hospitals and facilities around Australia and New Zealand to collaborate of research projects.

For more information about the ANZ Peritoneal Malignancy Collaboration please see below.

CRS Patient Information

For more information about Peritonectomy Surgery at RPA please view our Peritonectomy Surgery Patient Information Booklet here.

ANZ Peritoneal Malignancy Collaboration (ANZ PMC)

Established in 2017, the Australian and New Zealand Peritoneal Malignancy Collaboration was set up with the overarching goal 'to improve the outcomes of patients with peritoneal malignancy'. The ANZ PMC is chaired by Professor Brendan Moran (Basingstoke, UK) and Professor Michael Solomon (RPA, Sydney) and aims to support and promote research and collaboration amongst the eight peritonectomy sites throughout Australia and New Zealand.

• Royal Prince Alfred Hospital - Sydney
• St George Hospital  - Sydney
• Peter MacCallum - Melbourne
• Princess Alexandra - Brisbane
• Waikato - Hamilton NZ
• Joondalup Health Campus - Perth
• The Queen Elizabeth - Adelaide
• Auckland Hospital - Auckland NZ

Terms of reference for the collaboration can be found here