Definition & Overview
A peritonectomy is a surgical procedure used to remove the lining of the abdominal cavity, often due to malignancy. It is commonly performed in combination with a cytoreductive surgery and followed by chemotherapy. Its goal is to remove as much of the tumour as possible to increase the patient’s chances of recovering from the condition.
In the past, peritonectomy was considered a high-risk procedure, but outcomes have significantly improved in recent years with the mortality rate dropping from 10% to just 1% over a period of two decades. Thus, it is now commonly performed for the treatment of several types of abdominal cancer.
Who Should Undergo and Expected Results
Peritonectomy is for patients who are diagnosed with malignant abdominal tumours or abdominal cancers, such as:
Colorectal cancer – Studies show that colorectal cancer patients who undergo peritonectomy can achieve a 30% 5-year survival rating given that certain conditions are met, such as a low volume PC from CRC and complete cytoreduction.
Appendix adenocarcinoma - In one study, the procedure has a 49% 5-year survival rating for patients suffering from cancer affecting the appendix.
Peritoneal mesothelioma – Previously fatal, a peritoneal mesothelioma can now be treated with a 50% 5-year survival rating due to the advancement in peritonectomy.
Pseudomyxoma peritonei – The procedure has an 81% 5-year and 70% 10-year survival rating for this condition.
Ovarian cancer – Studies show that the procedure has reduced the risk of death due to ovarian cancer by 21%.
Gastric cancer – Peritonectomy is currently the only treatment that can provide gastric cancer patients with a 5-year survival rating.
Peritoneal carcinomatosis – Several abdominal cancers can cause carcinomatosis, and studies show that peritonectomy together with the radical resectioning of the tumours can achieve long-term survival in some patients.
Whether performed as a stand-alone procedure or in combination with other procedures, a peritonectomy is effective in:
- Relieving symptoms
- Increasing the likelihood of a successful cancer therapy
- Prolonging patients’ lives
Studies show that when used with cytoreductive surgery and chemotherapy, a peritonectomy can significantly extend a cancer patient’s lifespan by at least seven years following diagnosis. However, they still undergo a long and difficult recovery process following a successful procedure, with many patients remaining in intensive care for months.
How is the Procedure Performed?
Peritonectomy is a major surgical procedure performed on an in-patient basis. It is considered as one of the most complex surgeries and can take up to 14 hours to complete.
There are a number of different types of peritonectomy performed depending on which part of the abdominal organs is affected by cancer. Some examples are left or right upper quadrant peritonectomy and pelvic peritonectomy, among others.
During the actual procedure, the patient is placed in a supine position with the legs extended and supported. Following the administration of general anaesthesia, the surgeon will prepare the abdominal skin from the middle of the chest to the pubic area before making an incision from the xiphoid to the pubis to access the peritoneal surface. All malignant tumours and affected tissues are then resected. If there is a large volume of tumour, a complete omentectomy (the removal of the thin fold of abdominal tissue that encases the stomach) is performed.
If necessary, the surgeon will perform a reconstructive procedure after peritonectomy so the abdominal organs can still function as normally as possible after the procedure. The incision is then closed up using absorbable sutures. Tubes and drains will also be inserted to allow early post-operative intraperitoneal chemotherapy and prevent fluid accumulation in the chest.
Patients are usually required to stay in the hospital for up to 14 days, during which they can undergo chemotherapy. If the procedure involved a cytoreduction, patients may require food and medications to be administered intravenously via a nasogastric tube. Most patients use the tube for up to four weeks after the procedure or until the digestive system has fully recovered.
Possible Risks and Complications
As a major surgical procedure, a peritonectomy comes with certain risks, such as:
- Excessive bleeding
- Prolonged paralytic ileus
- Systemic or local toxicity of chemotherapy
- Severe abdominal pain
- Bone marrow depression
There is also a high risk of morbidity and mortality despite the efficacy of the procedure. Morbidity rating is between 20 and 35 percent, whereas mortality ranges between 4 and 8 percent. Morbidity risk factors include the extent of surgery, an anastomotic leak, rising intraabdominal target temperature, and the stage of cancer. Thus, patients are carefully selected through PCI and scanning tests, and the benefits of the procedure are always weighed against its risks before a peritonectomy is performed.
Morris DL. “Peritonectomy HIPEC-contemporary results, indications.” Chin J Cancer Res. 2013 Aug; 25(4): 373-374. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3752351/
Sugarbaker PH. “Management of peritoneal surface malignancy using intraperitoneal chemotherapy and cytoreductive surgery: A manual for physicians and nurses.” Washington Cancer Institute. http://www.surgicaloncology.com/gpmtitle.htm