When cancer spreads from an abdominal organ to the peritoneum, the thin lining that covers the abdominal cavity and its organs, treatment can become more complex. This condition is known as peritoneal carcinomatosis or peritoneal surface malignancy. In carefully selected patients, Surgery for Cytoreduction may be considered to remove visible cancer deposits from the abdominal cavity, often followed by Hyperthermic Intraperitoneal Chemotherapy (HIPEC).
The procedure is different from conventional surgery for abdominal cancer because the surgeon may need to remove tumour deposits from multiple surfaces or organs. Careful patient selection, detailed imaging, multidisciplinary evaluation and specialist surgical expertise are important when considering this treatment.
Surgery for Cytoreduction (CRS) aims to remove all visible cancer deposits from the peritoneal cavity. Depending on where the disease has spread, Surgery for Cytoreduction may involve removing affected portions of the peritoneum as well as selected organs or parts of organs.
The reference information explains that cytoreduction may be combined with HIPEC. During HIPEC, a heated chemotherapy solution is circulated inside the abdomen after the visible tumour has been surgically removed. The solution is maintained at approximately 42–43°C, with the objective of treating microscopic cancer cells that may remain after surgery.
This combined approach may be considered for selected patients with cancers such as:
Whether CRS and HIPEC are appropriate depends on several factors, including the type and extent of cancer, the patient’s general health and whether complete or meaningful tumour removal is technically possible.
The primary objective of cytoreduction is to remove visible tumour deposits from the abdominal cavity. The extent of surgery varies considerably from patient to patient.
In some cases, the surgeon may need to remove affected sections of the small or large intestine, gallbladder, spleen or portions of the peritoneal lining. The exact procedure is determined after evaluating the location and spread of the cancer.
Once cytoreduction has been completed, HIPEC may be administered. Unlike intravenous chemotherapy, HIPEC delivers heated chemotherapy directly into the abdominal cavity. The treatment is then drained before the surgical incision is closed.
The combination of surgery and intraperitoneal chemotherapy is intended to address both visible and microscopic disease. However, not every patient with peritoneal cancer is suitable for this treatment.