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. When the mesothelioma involves many areas of the abdominal cavity, the cytoreductive surgery may involve removing portions of various organs, including the stomach, intestines, liver, pancreas, and spleen, among others.
When performed as stand-alone procedures, peritonectomy and cytoreductive surgery can give patients relief from abdominal pain and loss of appetite. However, doctors often perform cytoreductive surgery in combination with other treatments. When used with chemotherapy, the surgery has the ability to kill cancer and extend life span. This combination has helped some patients to live seven years or longer after diagnosis.
Cytoreduction is a complex procedure that generally lasts 10 to 12 hours. Because this mesothelioma surgery is so lengthy, patients are sometimes 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).
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After surgery, patients can expect an extensive recovery period in the hospital and at home. Many patients have a post-op hospital stay of more than a week. 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 – is most commonly delivered after the tumor cytoreduction is complete. This generally lasts 90 minutes, while the patient is still under general anesthesia.
Most patients will be able to start eating several days after surgery. At times, the intestines are slow to recover from the surgical and chemotherapeutic stress and IV nutrition may be used during this time to maintain nutrition.
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 can experience significant complications after cytoreduction.
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.
Surgical oncologist and peritoneal specialist Dr. W. Charles Conway is director of surgical oncology at the Ridley-Tree Cancer Center in Santa Barbara, California. He specializes in gastrointestinal cancers and peritoneal surface malignancies, including mesothelioma.
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