Peritoneal carcinomatosis is a complicated medical situation. It supposes the dissemination within the abdominal cavity of neoplasias frequently of digestive or gynecological origin. Affected patients have an opportunity to be treated, sometimes with curative intent, by performing extensive cytoreduction procedures in combination with the use of intraperitoneal intraoperative hyperthermic chemotherapy (HIPEC).
Symptoms of peritoneal carcinomatosis
Most of the time patients are asymptomatic. The discovery of the disease can be made during surgery of the primary tumor or other unrelated surgery, or in follow-up in external consultations. Other times the peritoneal spread of cancer generates symptoms such as abdominal distention due to accumulation of intra-abdominal fluid, intestinal obstruction, etc.
When to treat peritoneal carcinomatosis
In those pathologies that benefit from combination therapy, the results obtained are much higher than those achieved with the exclusive administration, and without curative intent, of systemic chemotherapy. This treatment is effective in scenarios such as peritoneal carcinomatosis due to appendicular neoplasias, peritoneal malignant mesothelioma, colorectal cancer and increasingly is being evaluated in patients with advanced ovarian cancer. In other pathologies it is necessary to individualize the indication.
The management of some clinical situations is changing and now tends to have a more active attitude in patients with high risk factors to develop peritoneal carcinomatosis during follow-up. In these patients the performance of a second surgery, with consolidation HIPEC, improves the results fundamentally because it reduces the rates of peritoneal recurrence. The most important clinical situations are reflected in the following table:
Surgery for peritoneal carcinomatosis
The procedure consists of the accomplishment of a maximum effort surgery, with procedures of peritonectomy to obtain the extirpation of all the visible disease to the eyes of the surgeon. This surgery can take several hours and require multiple visceral resections that may involve all intra-abdominal viscera.
After resection of the macroscopic disease, it is known that there will be a multitude of malignant cells disseminated in the abdominal cavity, so that, in order to effectively treat this microscopic component, which the surgeon does not see, HIPEC administration is used.
The effect of HIPEC treatment is achieved by the use of high doses of chemotherapy, directly applied in the abdominal cavity and enhanced its effects by the use in conditions of hyperthermia. It is a complex procedure that must be performed by surgical teams with extensive experience in this type of surgery.
Postoperative of peritoneal carcinomatosis
After surgery, the patient usually stays for a few days in the intensive care unit or anesthesia resuscitation. After its transfer to the plant, appropriate measures will be initiated for pain control, the initiation of ambulation and mobilization in addition to oral tolerance to food. An average hospital admission is usually required around 15 days.
Care tips and recommendations after surgery
Follow the recommendations of your medical team faithfully and consult with the slightest doubt. No issue is small in these circumstances.