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Cytoreductive Surgery + HIPEC

Maximal debulking for peritoneal carcinomatosis

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Genel Cerrahi department. Book Appointment →

What is Cytoreductive Surgery + HIPEC?

Cytoreductive surgery (CRS) is the radical excision of all visible tumor tissue in the peritoneal cavity; followed by lavage of the peritoneal cavity at 42-43°C with a chemotherapeutic agent (mitomycin-C, oxaliplatin, cisplatin).

It provides long survival in selected patients with primary peritoneal mesothelioma, pseudomyxoma peritonei (originating from appendiceal mucinous neoplasm), peritoneal spread of ovarian cancer and colorectal cancer peritoneal metastases.

When performed with peritoneal cancer index (PCI) ≤ 20 and complete cytoreduction (CC-0/CC-1), five-year survival can reach 40-60%; however, due to high morbidity (25-50%) and mortality (2-5%), evaluation in a multidisciplinary center is essential.

Symptoms

Abdominal distention and ascites (peritoneal spread)
Abdominal pain and early satiety
Jelly belly appearance (pseudomyxoma)
Signs of bowel obstruction
Weight loss and cachexia
Recurrent inguinal or umbilical hernia (PCI marker)
Palpable mass and hepatomegaly
Elevated tumor markers (CA 19-9, CA 125)

Risk Factors

PCI > 20 (difficulty of complete cytoreduction)
Extensive small bowel involvement
Hepatic parenchymal metastasis
Retroperitoneal spread
Large peroperative tissue loss
Resistance to preoperative chemotherapy
Inadequate cardiopulmonary reserve
BMI > 35 (technical difficulty)

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Fever > 38.5°C in the first 72 hours postoperatively
  • Anastomotic leak signs (fecaloid drain output)
  • Massive pleural effusion (after HIPEC)
  • Signs of renal failure (cisplatin nephrotoxicity)
  • Signs of bone marrow suppression (3-4 weeks)

Treatment Methods

01
Preoperative CT/MR and laparoscopic PCI assessment
02
Midline laparotomy from xiphoid to pubis
03
Systematic peritoneal exploration and tumor mapping
04
Multivisceral resections: peritonectomies, omentectomy, splenectomy, colectomy
05
Goal: CC-0 (no residual tumor) or CC-1 (< 2.5 mm) cytoreduction
06
HIPEC closed or open (coliseum technique) perfusion, 42-43°C, 60-90 minutes
07
Anastomoses performed after HIPEC (to preserve viability)
08
Intensive care monitoring (48-72 hours) and total parenteral nutrition

Which Department to Visit?

You can visit our Genel Cerrahi department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.