19 Jul Mother of all operations
Cytoreductive surgery is a radical treatment for rare cancers of the abdominal cavity, but it has a good success rate says Mr Tom Cecil, Consultant Colorectal Surgeon at BMI The Hampshire Clinic
BMI offers many several speciality services, such as the colorectal service at Basingstoke Hospital where Mr Tom Cecil is based. As a consultant colorectal surgeon, he has been Clinical Director of the Peritoneal Malignancy Institute, one of the largest centres in the world in the treatment of peritoneal cancers.
His area of expertise is a rare cancer known as Pseudomyxoma Peritonei or PMP, which is a cancer of the peritoneum, the lining of the abdominal cavity. It affects a tiny a proportion of people, around 2-3 in a million, but can be widespread and requires radical surgery. It is also known as jelly belly because of the way the tumour and mucus form in the abdomen, and when Mr Cecil sees a patient it has usually been diagnosed through a previous abdominal operation or found on a scan.
“The symptoms include a distended abdomen, discomfort, difficulties eating and pain. By the time we see them they have often had an operation because they may have presented with an ovarian mass. Increasingly with CT scans the condition is being picked earlier, but often in the overseas patients it would have been diagnosed in an operation,” says Mr Cecil who uses the Sugarbaker operating technique. Developed by
Dr Paul Sugarbaker in the United States, it is known as the Mother of all Operations as it can take around 10 hours and involves 2-3 surgeons.
The peritoneum is a membrane that lines the abdominal cavity and covers the abdominal organs, acting as a lubricating structure to allow the small and large bowel to function. Rarely, the peritoneum can develop a primary malignancy, such as a peritoneal mesothelioma, but most commonly peritoneal tumours are secondaries from any abdominal organ, particularly ovarian, appendix and bowel cancers. Whilst this is very serious and often a lethal event, a novel radical approach, combining aggressive removal of the peritoneal tumour by extensive surgery (termed Cytoreductive Surgery (CRS)) combined with intra operative Hyperthermic Intra Peritoneal Chemotherapy (HIPEC), results in prolonged survival and potential for cure. Effectively this is a 30 to 90 minute warm chemotherapy bath designed to eliminate tiny tumours and tumours too small to see.
The operation involves removing the complete tumour, stripping the lining of the abdomen and operating on the small intestine, colon, rectum, liver, gall bladder, spleen omentum, and in women, the ovaries and uterus.The abdomen is then washed out with hot chemotherapy liquid for one hour, applying the treatment to the precise area and thus reducing the side effects of chemotherapy and allowing for a quicker recovery.
The UK Pseudomyxoma Peritonei National Centre at Basingstoke, led by Mr Cecil, is the largest in the world and one of only two in the UK. It has treated more than 1000 patients with a high rate of successful outcomes. PMP has a 60-70 per cent survival rate for 10 years, higher than for colon cancer, and patients recover very well within three to four months.
“The average inpatient stay is three weeks but most go home in less time. Those who stay have complications, which there is a risk of in this surgery. It’s major surgery but we achieve it with quite a low mortality. It’s unusual that people don’t survive, but it is a big operation. Then they have a good quality of life,” says Mr Cecil. “Sometimes they stay in the UK for a few months until they are successfully recovered and they can come back if they are worried. A lot of the follow up is done through CT scans and we can follow up remotely with the local teams.”
Curated from Article – Collaborate