If there are just one or two isolated metastases in an easily accessible position, your oncology team is likely to ask a specialist peritoneal team to review your case and give an opinion on whether an operation to remove them might be successful. The team may recruit additional specialists if the metastases are affecting the bladder, ureters or kidneys for example, or the reproductive system in women (ovaries or uterus).
The specialist team will evaluate the case as part of a multidisciplinary team (MDT) and identify the extent of the disease, whether all the tumours can be removed or if there is disease that would lead to a poor outcome from surgery. Involvement of the small bowel is particularly difficult to treat.
Sometimes the MDT will be unable to decide whether major surgery is possible or sensible and will undertake a keyhole inspection of the abdomen (laparoscopy) as this can sometimes identify disease that has not been picked up on the scans.
When you have cytoreductive surgery, if the surgeons were able to remove all the disease they will introduce heated chemotherapy fluid (HIPEC) into the abdomen while you are still under the anaesthetic. Different drugs are used depending on whether you had chemotherapy before the surgery. The fluid bathes the affected organs for up to two hours and is then drained out.
The average length of the treatment for complete tumour removal and HIPEC is ten to twelve hours. The majority of patients recover quickly and are out of hospital within two to three weeks. There are very few side-effects from this chemotherapy as it works on local tissues and not via the blood stream.
This procedure is currently only available at The Christie Hospital, Manchester; North Hampshire Hospital, Basingstoke, Hants; St Mark’s Hospital, Harrow, NW London; and Good Hope Hospital, Sutton Coldfield, West Midlands. There may be further centres in the future, so please check check back with this page.