Peritonectomy

Peritoneal mesothelioma is the second most common type of this rare form of cancer. Pleural mesothelioma is the most common and while it affects the mesothelium of the chest cavity, peritoneal mesothelioma is the cancer of the tissue lining the abdominal cavity. As with its more common counterpart, this type of mesothelioma is difficult to treat and patients do not usually have a good prognosis.

One treatment option that provides the most hope of remission or extending survival times is a peritonectomy. This is a surgical procedure that removes all or some of the peritoneum, the abdominal lining. It is most often combined with a type of chemotherapy called HIPEC, hyperthermic intraperitoneal chemotherapy. When used together, the hope of remission, the reduction of symptoms and extended life expectancy is good.

Peritoneal Mesothelioma

The peritoneum is the part of the mesothelium that lines the abdominal cavity and the organs in the abdomen. Mesothelioma is most strongly associated with inhaling asbestos fibers, which is why the pleural form of the cancer is most common. However, those fibers may also be accidentally ingested or they may migrate from the chest cavity to the abdominal cavity and cause damage that leads to peritoneal mesothelioma.

Survival rates for peritoneal mesothelioma are not high. About one quarter of people diagnosed will live for three or more years. Treatments can extend this life expectancy and if the cancer is diagnosed in an early stage, there is a small chance of a cure or remission. One of the best ways to achieve remission, if possible, is through surgery to remove cancerous tissue.

What Is a Peritonectomy?

Peritonectomy is a type of cytoreductive surgery, which means that it is used to remove as much cancerous tissue as possible. The term peritonectomy refers specifically to the removal of the peritoneum, but this surgery may also include removal of parts of any organ that has cancerous tissue: the intestines, gall bladder, liver, stomach, pancreas, or spleen.

The purpose of the surgery is to relieve symptoms, slow the progression of the cancer, and to achieve remission, although the latter is not always possible. To improve the odds of remission and to reduce the chance of a recurrence after surgery, the procedure is often combined with chemotherapy. This can eliminate cancer cells that the surgeon was not able to remove safely.

Hyperthermic Intraperitoneal Chemotherapy

For peritoneal mesothelioma the type of chemotherapy often used after surgery is HIPEC. This is a newer way to use chemotherapy and it involves heating the drugs and injecting them directly into the abdominal cavity. This is in contrast to the typical way in which chemotherapy drugs are administered: intravenously to the whole body.

HIPEC has been found to be more effective for treating peritoneal mesothelioma than the standard way of delivering chemotherapy. Some studies have found that treatment with HIPEC gives patients a 50 percent chance of surviving five years later, a major achievement for treating a disease that has previously been considered so difficult to manage. Longer survival times after HIPEC are associated with having a certain subtype of mesothelioma, called epithelial, extensive cytoreduction surgery, and the removal of affected lymph nodes.

Benefits of Peritonectomy

The goals of a peritonectomy followed by HIPEC are multiple: to reduce symptoms and provide palliative care for patients, to extend survival times for patients, to achieve remission, and to cure the cancer. Remission and a cure are not possible for many patients, but for those with early-stage mesothelioma, there is hope that this combination of treatments could be curative or that it could at least lead to long-term remission.

For patients that have minimal hope of achieving remission, extending life is a goal and possible benefit of the surgery. For those with advanced cancer and for all patients undergoing a peritonectomy, a benefit of the surgery is relief from symptoms. The removal or reduction of tumors in the abdomen can reduce pain and swelling and make patients feel more comfortable.

Risks and Complications

Peritonectomy followed by HIPEC is major surgery, but it is not as risky as some of the radical surgeries used to treat pleural mesothelioma. It does not, for instance, require the removal of an entire organ like the removal of a lung for an extrapleural pneumonectomy for pleural mesothelioma. Older patients are more likely to have complications from the surgery, but anyone is susceptible.

Possible complications include fistulas in the bowels, bile leaks, and excessive bleeding. Other complications are the same as those seen with any major surgery, like blood clots and infections. It is also possible that a patient will go through this surgery and struggle to recover, only to find that the cancer has recurred soon after.

Organ Damage and the Need for an Ostomy

An ostomy is a procedure that can be done to divert the digestive tract or the urinary tract to the outside of the body. The procedure involves creating 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.

Ostomies are typically done when the bladder or bowels cannot function normally due to disease. In rare cases, though, damage to those organs may occur as a complication of surgery, warranting an ostomy. It is not a common complication, but any surgery in the abdominal cavity, including a peritonectomy, may result in damage that requires an ostomy. The ostomy may be permanent while the damage is repaired or the tissue heals, or if the damage is severe it may be permanent.

Living with an ostomy presents a lot of challenges. It requires having an ostomy bag to collect feces or urine. The patient can no longer control when waste passes from the body because a stoma does not have a valve or muscle to shut off flow. The constant collection of waste in a bag can cause social issues, relationship difficulties, and mental and emotional stress for the patient. An ostomy also has to be cleaned and cared for regularly to avoid infections and irritations. An ostomy nurse helps patients learn to do this for themselves, especially if the ostomy is permanent.

Recovery

Recovery from a peritonectomy will vary in duration by patient. Younger, healthier patients and those in the earlier stages of cancer will likely recover sooner and with fewer complications. Because there are possible complications, patients must stay in the hospital for a period of time after the surgery and chemotherapy. There they may receive intravenous medications, fluids, and nutrition while the digestive organs heal. A tube is also used to drain the stomach and bowels. This is necessary for a few weeks until the patient is healed enough to be able to eat and digest normally. Recovery at home follows a stay at the hospital and may require a few weeks of bed rest before the patient is fully recovered.

Peritoneal mesothelioma is a serious and aggressive type of cancer. The prognosis has never been good for this illness, but with innovations in treatment, survival times are increasing. The use of cytoreductive peritonectomy surgery followed by HIPEC is proving to be an effective way to help patients survive longer, and for a very few to find a cure. If you are facing treatment for peritoneal mesothelioma, be sure that you know what your options are. Rely on your medical team to help you understand the risks and benefits of a peritonectomy and lean on your family for support as you go through this difficult time.