Cytoreductive surgery is a highly specialized surgical procedure during which the surgeon removes parts of the inner lining of the abdomen known as peritoneum using peritonectomy as well as affected organs or their parts such as the colon or small intestine, spleen, uterus and ovaries, gallbladder etc. The goal of cytoreductive surgery is complete removal of all visible tumor deposits. It is a complex surgical procedure for which surgeons need to receive dedicated training, specialize in it and have considerable experience with this type of surgery.
Hyperthermic intraperitoneal chemotherapy (HIPEC) is usually combined with cytoreductive surgery with the goal of eliminating microscopic residual disease which may be present at the end of cytoreductive surgery. During HIPEC, which is delivered as part of the same surgical intervention, the chemotherapy solution is circulated through the abdominal cavity heated to 41-42ºC in order to improve its efficiency and depth of penetration.
A multidisciplinary team lead by a surgical oncologist specialized in peritoneal surface malignancies decides whether cytoreductive surgery and HIPEC are recommended based on the molecular characteristics and biology of the primary tumor, the extent of the disease, involvement of organs and the overall condition of the patient.
If cytoreductive surgery, with or without HIPEC, is not possible, some patients may be candidates for pressurized aerosolized intraperitoneal chemotherapy (PIPAC). PIPAC is a technique that does not involve surgical resection of tumor deposits and focuses on the delivery of chemotherapy in the abdominal cavity by laparoscopy. It is a minimally invasive procedure that is usually repeated three times to maximize the result but can be repeated again if there is good response. Some patients show an excellent response of the tumor deposits to PIPAC and as a result may become candidates for surgery.
