Peritonectomy/cytoreductive surgery is a treatment for peritoneal mesothelioma that removes all or some of the peritoneum and cancerous tissue. It improves survival rates when surgeons follow this procedure with HIPEC, hyperthermic intraperitoneal chemotherapy. A cure may even be possible.
The peritoneum is the part of the mesothelium that lines the abdominal cavity and the organs inside. The pleural form of mesothelioma is most common because this type of cancer is strongly associated with inhaling asbestos fibers.
However, a person may also swallow the fibers. Inhaled or ingested fibers may also migrate from the chest cavity to the abdominal cavity, causing tissue damage that leads to peritoneal mesothelioma.
Survival rates for peritoneal mesothelioma tend to be poor. About one-quarter of people diagnosed will live for three or more years. Treatment can extend life expectancy.
If the cancer diagnosis is in the early stages, there is a slight chance of a cure or remission. The best way to achieve remission is by surgically removing cancerous tissues.
What Is a Peritonectomy?
Peritonectomy is a form of cytoreductive surgery. Cytoreductive surgery is any surgical procedure that removes cancerous tissue.
The term peritonectomy refers specifically to the removal of the peritoneum. The surgery may also remove parts of organs with cancerous tissue. Organs that may be affected are the small intestines, large intestine, gallbladder, liver, stomach, pancreas, and spleen.
Surgeons mostly use this procedure to relieve symptoms. It may also slow progression and lead to remission, although the latter is not always possible.
The procedure is often combined with chemotherapy to improve the odds of remission and reduce the chance of a recurrence after surgery. This combination can eliminate cancer cells the surgeon could not safely remove or were too small to visualize during surgery.
Hyperthermic Intraperitoneal Chemotherapy
For peritoneal mesothelioma, HIPEC is often used after surgery. HIPEC is an innovative chemotherapy method that injects heated chemotherapy drugs directly into the abdominal cavity.
This differs from traditional chemotherapy, which administers drugs intravenously, allowing the drugs to circulate through the entire body.
HIPEC is proven more effective for treating peritoneal mesothelioma than standard chemotherapy. Some studies found that treatment with HIPEC gives patients significantly extended survival times.
This is a major achievement for treating a disease that was previously so difficult to manage. The increased survival time after HIPEC is associated with the epithelial subtype of mesothelioma.
Benefits of Peritonectomy
There are several goals of peritonectomy followed by HIPEC. These procedures tend to be palliative, aiming to reduce symptoms, extend survival times, and achieve the best chance at long-term remission.
Curing peritoneal mesothelioma is a realistic goal for some patients. Patients in earlier stages of the disease have a better opportunity for long-term remission.
For most mesothelioma patients, this surgery is used to extend life. For those with advanced cancer, a benefit of peritonectomy is relief from symptoms. Removing tumors in the abdomen can reduce pain and swelling, allowing the patient to feel more comfortable.
Risks and Complications
Peritonectomy followed by HIPEC is major surgery. While it may be less risky than radical surgeries used to treat pleural mesothelioma, it can still have significant complications.
Older patients or those with complex medical conditions are more likely to have postoperative complications from the surgery, yet anyone is susceptible.
Possible postoperative complications include:
- Fistulas from the bowels
- Leakage from sites where the bowel was sutured together
- Excessive bleeding
- Intra-abdominal infection
- Blood clots
Organ Damage and the Need for an Ostomy
Anytime there is an operation in the abdominal cavity, there is a small risk of injury to the bowel or urinary tract. If injury or obvious tumor involvement prohibits the surgical repair, an ostomy might be necessary.
An ostomy is a surgical procedure that diverts the digestive or urinary tract to the outside of the body. The procedure creates an opening, called a stoma, that links the small intestine, large intestine (colon), or ureter to the outside of the body, bypassing the normal routes through which waste is expelled from the body.
Doctors typically perform ostomies when the bladder or bowels cannot function normally due to disease. In rare cases, organ damage may occur as a complication of surgery.
It is not a common complication, but any abdominal surgery, including a cytoreductive surgery, may result in damage that requires an ostomy. The ostomy may be permanent or may only be temporary to allow affected tissue to heal.
Living with an ostomy presents many challenges. Patients need an ostomy bag to collect feces or urine. The stoma does not have a valve to shut off the flow, the patient cannot control when waste passes from the body.
Specialty ostomy nurses are an invaluable resource to provide a plan for management, including problem-solving for any issues that arise. It can be emotionally challenging to deal with complex body image changes. These can either be temporary or permanent. If a reversal is possible, it will require another surgery.
Recovery from cytoreductive surgery plus HIPEC varies by patient. Younger, healthier patients and those in earlier cancer stages typically recover more quickly and with fewer complications. If there is a complication, patients must remain in the hospital after surgery and HIPEC chemotherapy.
Patients may receive intravenous medications and fluids after surgery. Initially, there is often a tube to drain the stomach until normal bowel function returns. The goal is to return to a modified diet as soon as possible. Having a nutritionist can be very helpful in providing new dietary recommendations. Once patients go home, they will be on modified activity until fully recovered.
Peritoneal mesothelioma is a serious and aggressive cancer. The prognosis for this illness is generally poor; however, innovative treatment options have increased survival times. Cytoreductive surgery, including peritonectomy followed by HIPEC, is an effective way to help patients live longer.
For some, this procedure may even provide a cure. If you are facing treatment for peritoneal mesothelioma, know your options. Your medical team can help you understand the risks and benefits of these aggressive treatments for peritoneal mesothelioma.Get Your FREE Mesothelioma Packet
Page Medically Reviewed and Edited by Paul Sugarbaker, M.D.
Dr. Paul Sugarbaker is a leading expert in surgical oncology. He specializes in the surgical treatment of gastrointestinal cancers, peritoneal mesothelioma, and peritoneal metastases. He developed and advanced an important treatment procedure for peritoneal cancers and metastases known as HIPEC. The innovative strategy uses surgery followed by the circulation of heated chemotherapy drugs in the abdomen. Dr. Sugarbaker currently heads up the Peritoneal Surface Malignancy Program and the Center for Gastrointestinal Malignancies at Washington Hospital Center. He also works out of a private practice, Sugarbaker Oncology Associates.