Peritonectomy, a form of cytoreductive surgery, is one of the mainstays of treatment for malignant peritoneal mesothelioma. The procedure’s primary purpose is to remove cancerous tissue from the lining of the abdominal cavity, known as the peritoneum.
Peritonectomy and other cytoreductive surgeries help to relieve symptoms of abdominal pain and appetite loss. When combined with chemotherapy, cytoreductive surgery can significantly extend an individual’s life.
Who Qualifies for Peritonectomy/Cytoreductive Surgery and Chemotherapy
Before cytoreductive surgery and chemotherapy are performed, a patient’s doctor will determine whether they are healthy enough to withstand surgery and its potential complications and live long enough to benefit from the treatment. The doctor will evaluate the health of the patient’s heart and lungs with electrocardiogram and pulmonary function tests. He or she will also assess the individual’s other health conditions and overall health status. Finally, imaging studies and other diagnostic tests and necessary procedures will be performed to determine the patient’s stage of disease.
For patients with poor overall health or more advanced disease, cytoreductive surgery would be futile and would only cause more pain. When this is the case, a palliative and multimodal approach is initiated to provide the patient with more tolerable therapies, such as systemic chemotherapy, radiation, or even experimental treatment, and the best combination of these therapies to extend their lifespan and improve their quality of life.
Cytoreductive Surgery: What to Expect
Individuals undergoing cytoreductive surgery are typically admitted to the hospital the day before the surgery. Preoperative tests are performed, including blood work and x-ray imaging. The surgery itself to remove all visible tumors within the abdominal cavity is a long and complex procedure. It generally takes 10 to 12 hours to perform.
Completeness of Tumor Resection Guides Treatment and Impacts Prognosis
Surgically removing as much cancerous tissue as possible makes chemotherapy more effective. Electrosurgery is the preferred method of cytoreductive surgery, as it achieves this goal more effectively than other methods. The area surrounding the tumors may often contain residual cancerous cells, which are quantified post-surgery via a completeness of cytoreduction score. This score ranges from zero to four, where a lower score indicates a lower percentage of remaining cancerous cells.
Some oncologists use the completeness of cytoreduction score to guide future treatment with chemotherapy and surgery. The associated guidelines indicate that patients with a score between zero and one will likely survive for an additional 3 years. In contrast, patients with a score between two and three have a life expectancy of roughly 6.5 months.
After the cytoreduction is done, and a completeness of cytoreduction estimate is made regarding the number of residual unresectable or microscopic tumors, heated chemotherapy is often performed. Heated chemotherapy is the other mainstay of treatment for malignant peritoneal mesothelioma. It involves bathing the abdominal cavity with heated chemotherapy drugs to kill any remaining cancer cells. It is most effective when it employs a two-drug combination.
Heated chemotherapy usually takes about 90 minutes to complete and is performed immediately after cytoreductive surgery while the patient is still anesthetized.
The post-surgery recovery process is also lengthy. Patients are often required to stay in the hospital for a week after the surgery. Most patients will resume their standard diet within a couple of weeks. However, sometimes the body is not able to immediately recover from surgery and chemotherapy. In these cases, nutrition may have to be administered intravenously until the body has recovered.1
Following discharge from the hospital, a patient’s typical recovery time at home lasts between two to three weeks. The main goal of recovery is reacclimatization of the digestive system. The next step in recovery is a gradual return to one’s prior activity level. After the first three months, when the abdominal incision has completely healed, and the individual’s strength has increased, quality of life increases and remains high for up to two years post-treatment. It is thought that decreases in quality of life after this time are due to disease recurrence.
Benefits of Peritonectomy/Cytoreductive Surgery and Heated Chemotherapy
Cytoreductive surgery with heated chemotherapy has been found to significantly extend survival in individuals with malignant peritoneal mesothelioma. The median overall survival is about 50 months.
In addition to being an effective treatment for malignant peritoneal mesothelioma, cytoreductive surgery with heated chemotherapy is also a beneficial palliative therapy for malignant ascites, a buildup of fluid in the abdominal cavity that commonly results from the disease. In the vast majority of cases, this treatment can completely resolve malignant ascites. It is believed that the chemotherapy component of the treatment is primarily responsible for the resolution of ascites.2
Peritonectomy and Cytoreductive Surgery