New Procedure Addresses Cancer of the Peritoneal Cavity

Cancer of the peritoneal cavity that originates from primary colorectal cancer, ovarian cancer, gastric cancer, appendiceal cancer, mesothelioma and peritoneal carcinomatosis has been virtually incurable.  For patients diagnosed with stage IV peritoneal carcinomatosis, survival is approximately four months.

Surgical therapy is producing promising results for some patients.  Cytoreductive (Debulking) Surgery (CS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) are aggressive treatments that have shown to increase life expectancy for well-selected patients with advanced abdominal cancers.

"Recently, a series of research studies have shown clear benefits for patients who have undergone CS and HIPEC surgeries," says Cleveland Clinic hepato-pancreato-biliary and transplant surgeon Sricharan Chalikonda, MD, who performs approximately four CS and HIPEC surgeries every month.  "For the right patients, we are starting to see survival rates increase by years."

CS is a complicated surgical procedure that takes up to 10 to 12 hours to perform.  It involves the destruction and/or resection of visible tumors within the peritoneal cavity.  Depending on the size and location of the tumors, the procedure also may involve the partial resection of various viscera, such as the small bowel, large bowel, spleen and uterus.

Removing all visible tumors is crucial to the patient's prognosis for long-term survival.  The patient's survival also depends on the volume of tumors within the abdomen and the aggressiveness of the carcinoma.  The patient's survival outlook decreases when all tumors cannot be eradicated or resected, unless they are less than 2.5 millimeters.

HIPEC facilitates the destruction of very small tumors that cannot be seen by the surgeon.  HIPEC also eliminates cancer cells that may be hiding or those that may have been released during resections of visible tumors or when portions of visceral organs have been removed.  The HIPEC procedure involves placing special catheters in the patient's abdomen.  Once the chemotherapy agent is heated to 42 degrees Celsius, it is distributed into the abdomen through the catheters for 100 minutes.

"HIPEC enables us to deliver higher concentrations of the chemotherapy agent into the perineoal cavity, which facilitates the destruction of remaining cancer cells," explains Cleveland Clinic gynecologic oncologist Pedro Escobar, MD, who operates with Dr. Chalikonda on gynecologic cases.

HIPEC causes fewer side effects than IV chemotherapy because of the peritoneal plasma barrier, which prevents the high concentrations of the chemotherapy solution from invading the blood stream.

Patients who may be candidates for CS and HIPEC are those with Stage IV cancer that is confined to the abdomen with no evidence of hematagenous spread of the disease.  Other factors include comorbidities, the type of cancer, surgical history and the patient's overall physical strength to withstand the CS and HIPEC procedures.

To make a referral or for more information, please contact the Specialty Services Access Line at 216.738.5439, 7 a.m. - 11 p.m., seven days a week.