Peritonectomy is the most common surgical procedure for peritoneal mesothelioma patients. The goal of the surgery is to remove the cancerous part of the lining of the abdominal cavity.
During a peritonectomy, an involved procedure called cytoreductive surgery is performed, which aims to remove as much cancerous growth as possible from multiple sites in the abdomen. It may involve the removal of parts of these six organs: bowels, gall bladder, liver, pancreas, spleen and stomach.
When performed as stand-alone procedures, peritonectomy and cytoreductive surgery can give patients relief from abdominal pain and loss of appetite. Doctors often perform cytoreductive surgery in combination with other treatments. When used with chemotherapy, the surgery has the ability to kill more cancerous cells and extend life span. This combination has helped some patients to live seven years or longer after diagnosis.
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Cytoreduction is a complex procedure that generally lasts 10 to 12 hours. Because the surgery is so lengthy, patients are frequently admitted to the hospital a day before the surgery. Doctors use the extra day for preoperative testing (X-rays, blood tests and other preparatory measures).
After surgery, patients can expect an extensive recovery period in the hospital and at home. Most patients have a post-op hospital stay of about 14 days.While there, they can have chemotherapy as potentially curative care.
A heated chemotherapy regimen – administered into the abdominal cavity for direct contact with cancer cells – begins during surgery and lasts about two weeks. Heated chemo aims to kill any cancer cells that were left behind by the cytoreduction.
Once discharged from the hospital, patients should expect another two or three weeks of recovery at home. A large part of this recuperation depends on the recovery of the digestive system, which experiences significant complications after cytoreduction.
For the weeks after cytoreduction surgery, patients receive food, fluids, vitamins and medications intravenously. Rather than relying on a faulty digestive tract, patients are connected to a nasogastric tube which goes from the nose and into the stomach. The nasogastric tube drains the contents of the stomach until the bowels can take over. This usually takes three or four weeks after surgery.
Mesothelioma experts consider peritonectomy and cytoreductive surgery critical to successfully treating peritoneal mesothelioma with a curative intent. Reducing the amount of visible cancer through surgery allows chemotherapy to better penetrate the cancerous cells that are invisible to the naked eye.
The more cancer a surgeon can remove the better chemotherapy will work for a patient, and this is why electrosurgery is used by surgeons instead of traditional scissor and knife tools. The margins around the removed tumor often contain microscopic cancerous cells. Surgical margins are assessed after surgery according to the Completeness of Cytoreduction Score, which evaluates the amount of potentially remaining cancerous tissue. Based on a scale of zero to four, lower scores indicate further removal of cancer in the margins.
Some experts believe the Completeness of Cytoreduction Score is the primary prognostic factor in peritoneal mesothelioma patients who qualify for surgery. Peritoneal patients with a score of zero or one survive 35.8 months, while patients with a score of two or three survive 6.5 months.
A combination of cytoreductive surgery and chemotherapy can help some patients become long-term survivors. In general, when peritoneal mesothelioma patients follow this treatment regimen, doctors report a median survival of approximately three years. One study of 49 patients achieved a median survival of 92 months (about 7.5 years). This is a drastic difference from the typical mesothelioma prognosis of one year or less.
If you have peritoneal mesothelioma, proper treatment can help you become a survivor. Treatments such as cytoreduction may add years to your lifespan. Discuss your situation with a mesothelioma specialist and create a personalized treatment plan.
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