Major milestone for complex cancer care

February 2019

RPA specialist team performs 100th case of radical cancer surgery

Jill Coinakis is optimistic she’s on track to defeat what she’s nicknamed “the beast” since first being diagnosed with cancer last year.

“It’s not going to stop me. I’ve got to live life. You’ve got to be positive. I’ve still got a lot of living to do. I’ve got grandchildren who I want to see grow-up,” the passionate home cook said from her home at Seven Hills in Sydney’s west.

Jill is the 100th patient who’s had radical cancer surgery performed by a highly-skilled multi-disciplinary team at Royal Prince Alfred hospital - an operation, which in some cases, may be a patient’s only hope for a cure.

The team performs a complex procedure for treatment of cancers of the peritoneum - the lining of the abdominal cavity. The cancer may have also spread to the surface of organs inside the cavity.

Jill, 68, was diagnosed with aggressive cancer of the appendix. Her surgeon was RPA’s Dr Nabila Ansari, who specialises in peritoneal malignancy surgery.

“The operation that we do is called cytoreductive surgery, or CRS. We remove all the visible tumours from the abdominal cavity,” Dr Ansari said.

“Then we add a heated chemotherapy drug into the cavity at the time of surgery to treat the cancer that may still be there but that we can’t see.”

That part of the procedure is called heated intraperitoneal chemotherapy or HIPEC.

RPA is one of two public hospitals in NSW where the surgery is performed. RPA’s first case was in April 2017 and last year, the team carried out -67 operations.

Jill’s operation saw them reach the 100th case milestone in January this year.

“It’s significant to reach 100 cases within 18 months of set-up. It reflects how hard everyone has worked,” Dr Ansari said.

“We have a new major operation that we’ve incorporated into our regular work. Our learning curve has been accelerated with the mentoring and guidance we have received from UK expert Professor Brendan Moran. “It was exciting when I found out I was the 100th patient who’d had the operation at RPA. There was a special cake at my bed in the ward,” she said.

There’d been months of preparation ahead of Jill’s surgery.

At RPA, only patients who have certain types of peritoneal malignancies  are considered for this type of surgery and they must undergo a series of assessments with a peritonectomy surgeon, a medical oncologist and other medical, nursing and allied health specialists to determine if they’re suitable candidates.

“It’s an invasive procedure which on average takes about seven hours. Patients need to be able to cope with the extent of the operation and the recovery,” Dr Ansari said.

If they’re given the go-ahead, the team’s Clinical Nurse Consultant Annie Tang co-ordinates the patient’s appointments with psychologists, pharmacists, social workers, physiotherapists and dieticians prior to surgery.

“I meet the patients at the very beginning with Dr Ansari. It helps to get to know them.

“It can be a struggle for patients and their families to deal with the diagnosis. I aim to make the process easier for them and the patients are very thankful for our help,” Ms Tang said.

For Jill, it meant joining a physical exercise program run at RPA and working with a dietician to get her in the best physical shape for surgery. She changed her diet and walked, swam and worked-out at the gym every day for three months supported by Manuel, her husband of 49 years, and her family.

“He was like a drill sergeant. But he said ‘You’ll thank me for it.’ He was determined to do it with me so that I didn’t lose faith. I lost 19 kilograms. My family was very supportive. They’re one-in-a-million,” she said.

Jill’s operation took close to eight hours. She spent 25 days in hospital after surgery and is now slowly recovering at home.

“It’s a massive operation. It’s not easy to do. Dr Ansari is in the operating theatre for hours. She’s so dedicated and so is her team. I think the world of them,” she said.

Since she’s been at home, Ms Tang has checked-up on her progress.

“Leaving hospital - where there’s 24/7 care and going home can be quite overwhelming. I call patients to say hello and let them know they’re not alone. I check that they’re eating ok, that their wound is healing properly and just to have a chat,” Ms Tang said.

A research team will also monitor Jill’s wellbeing for five years to help better understand the long-term effects of the surgery.

Jill and Manuel are hoping to head to Nelson Bay soon to celebrate their wedding anniversary.

“It’s all paid off. The operation was a success. There’s another journey ahead but I’m sure I’ll get through it,” Jill said.