What Is a Peritonectomy?

A peritonectomy is a procedure used to remove tumors from the lining of the abdominal cavity.

During a peritonectomy, doctors try to remove as much cancer from the abdomen as possible. This is called cytoreductive surgery. Surgery may involve removing portions of various organs. These include the stomach, intestines, liver, pancreas, and spleen, among others.

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.

A 2021 study looked at 40 mesothelioma patients who underwent peritonectomy. A total of 38 had a complete macroscopic tumor removal. Two patients had residual tumor nodules less than 2.5mm in size.

Diagram showing the six organs involved in a Peritonectomy or cytoreductive surgery

Surgical Consultation for Peritonectomy

Before having a peritonectomy, it’s important to meet with the surgeon and their team. This meeting can be done in person or online. It’s an opportunity for patients to learn more about the procedure and ask any questions they might have.

The surgical team will review all your medical records, imaging scans and biopsy results. This will confirm if you are eligible for a peritonectomy. They’ll also explain everything you need to know about preparing for surgery and recovery.

Cytoreductive Surgery Procedure

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).

Hospital Stay

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.

Heated Chemotherapy

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.

Home Recovery

Once discharged from the hospital, patients should expect another two or three weeks of recovery at home. A large part of this depends on the recovery of the digestive system. It can experience significant complications after cytoreduction.

Quick Fact:
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.

Completeness of Tumor Removal Impacts Prognosis

Mesothelioma experts consider this surgery critical to treating peritoneal mesothelioma. Reducing the amount of visible cancer allows chemotherapy to work better.

Surgeons often use a tool called electrosurgery instead of scissors and knives to remove as much cancer as they can. After the tumor is removed, doctors look at the area around it to see if any cancer cells are still there. They do this using something called Completeness of Cytoreduction Score which rates how much cancer might be left on a scale from 0-4. The lower the score, the less cancerous tissue that remains.

Effect on Life Span

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.

Another study, published in Anticancer Research in 2019, reported a 50% five-year survival rate among peritoneal mesothelioma patients who underwent cytoreductive surgery and heated chemotherapy. However, the same study also reported a 75% five-year survival rate among patients who underwent radical surgery similar to cytoreductive surgery and traditional systemic chemotherapy that wasn’t heated.

If you have peritoneal mesothelioma, proper treatment may 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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