Peritonectomy for Mesothelioma
Peritonectomy is a surgery that removes peritoneal mesothelioma tumors from the belly. It involves removing all or part of the abdominal lining. It often comes directly before heated chemotherapy (HIPEC). For select patients, surgery with HIPEC is considered the gold standard surgical treatment for peritoneal mesothelioma.
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What Is a Mesothelioma Peritonectomy?
Peritonectomy is a surgical treatment for cancers that develop in the abdomen. It removes all or part of the abdominal lining (the peritoneum) and attached tumors. Peritonectomy treats a few cancers, including peritoneal mesothelioma and ovarian cancer. It is a form of cytoreductive surgery (CRS), which means it reduces the amount of tumor tissue in a patient’s body.
- Surgical procedure: Peritonectomy is a form of cytoreductive surgery (CRS) that removes the abdominal lining and visible tumors.
- Treatment approach: Peritonectomy is usually followed by heated chemotherapy (HIPEC) during the same operation.
- Procedure time: Peritonectomy with HIPEC commonly takes 6 – 14 hours.
- Recovery: Patients generally spend 10 – 22 days in the hospital, with full recovery commonly taking at least three months.
Cytoreductive surgery (CRS) with HIPEC is considered the gold standard surgical treatment for select patients with peritoneal mesothelioma.
During HIPEC, doctors circulate heated chemotherapy through the abdominal cavity to kill cancer cells that may remain after surgery. In the largest peritoneal mesothelioma registry to date, 92% of patients who underwent cytoreductive surgery also received HIPEC.
Who Is a Candidate for Peritonectomy With HIPEC?
Not every patient with peritoneal mesothelioma is a candidate for peritonectomy with HIPEC. Doctors consider several factors when deciding whether the treatment may be appropriate, including:
- Cancer spread: Doctors generally recommend surgery when mesothelioma has not spread beyond the abdomen.
- Tumor extent: The peritoneal cancer index (PCI) helps doctors measure how extensively cancer has spread within the abdomen.
- Tumor removal: Doctors consider whether they expect to be able to remove all or most of the visible cancer.
- Overall health: Patients need to be healthy enough to undergo a lengthy operation and recovery.
A mesothelioma specialist can evaluate these factors and help patients understand whether surgery may be an option.
What to Expect When Undergoing a Mesothelioma Peritonectomy Procedure
Peritonectomy is a common operation that allows surgeons to remove tumors throughout the abdomen. Doctors usually make a large incision to do this surgery, and the recovery process may take months. But patients can take specific steps to prepare for surgery and help ensure a good outcome.
Patients can discuss peritonectomy preparation and recovery with their oncologists. A mesothelioma specialist can help them set realistic expectations.
How to Prepare
Patients can take steps to prepare for their peritonectomy procedures. The care team should provide detailed instructions for required and optional preparations. Patients generally stop eating solid foods about 24 hours before surgery. They also entirely stop eating and drinking starting at midnight the night before surgery.
Before surgery, patients commonly undergo a full workup, sometimes called a pre-admission workup. This can include blood tests, imaging scans and consultations with multiple specialists. This workup helps ensure the patient is prepared and can achieve an optimal outcome.
Because the day may be stressful, patients may want to bring along a comfort bag with helpful supplies like comfy clothes and headphones. They may also need to arrange for transportation to and from the hospital or cancer center.
Each patient’s peritonectomy experience will be unique. Procedure details can differ between surgeons and hospitals, but they generally share these basic steps:
- The surgeon makes an incision in the abdomen.
- The surgeon uses special tools to remove the affected parts of the abdominal lining.
- The surgeon removes portions of other affected tissues like the stomach or intestines.
- The surgery team preps the patient and administers HIPEC. This step is optional but common.
- The surgeon repairs any important tissues that underwent tumor removal. This step may happen before or after HIPEC.
- The surgeon closes the incision, and the patient moves to the recovery area.
Peritonectomy with HIPEC commonly takes 6 – 14 hours. The treatment team can communicate everything necessary for a patient and their loved ones to navigate this lengthy procedure. Patients should feel free to ask the care team any questions they have about peritonectomy for mesothelioma.
What to Expect After a Mesothelioma Peritonectomy Procedure + HIPEC
Peritonectomy recovery can vary depending on many factors. The treatment team can help patients understand what to expect and how to best manage recovery. In general, patients spend a few weeks in the hospital, then a few months recovering at home.
Recovery From Peritonectomy + HIPEC
Recovery from peritonectomy with HIPEC starts with a couple days of close monitoring. This generally happens in the intensive care unit (ICU), where staff are trained to care for patients after major surgeries. From there, patients usually end up staying in the hospital for 10 - 22 days, depending on how extensive the surgery was. Once discharged, the care team can work with the patient to ensure effective home care.
Patients may feel tired or less energetic for a few months after surgery. Experts say staying active is helpful and may help prevent complications like blood clots. Full recovery commonly takes at least three months.
Patients should attend their scheduled follow-up appointments and stay in touch with the treatment team. This can help doctors catch any complications and provide timely treatment.
Benefits of Peritonectomy + HIPEC for Mesothelioma
Peritonectomy can provide several benefits for peritoneal mesothelioma patients, including improved prognosis. Additional peritonectomy benefits include:
- Better survival rates: Peritonectomy with HIPEC has been associated with long-term survival in eligible patients with peritoneal mesothelioma.
- Decreased tumor volume: Peritonectomy removes mesothelioma tumors. This may allow HIPEC to be more effective, as it has less cancer to fight.
- Improved quality of life: Multiple studies show peritonectomy and HIPEC can improve quality of life for patients with abdominal cancers.
Experts estimate peritoneal mesothelioma survival is about one year without peritonectomy and HIPEC. In a large multi-institutional study of patients treated with cytoreductive surgery, most of whom also received HIPEC, 81% were alive one year after treatment. Overall median survival with peritonectomy and HIPEC is about four to five years. Patients who achieve a complete cytoreduction have reported median survival beyond seven years in some series. Patients wondering how this treatment may benefit them should discuss it with their doctors.
Peritonectomy + HIPEC Side Effects and Risks
All medical procedures, including peritonectomy and HIPEC, come with a risk of complications. Peritonectomy side effects may include bleeding, blood clots and other common surgery complications.
Patients can discuss peritonectomy risks and management with their treatment teams. This can help them identify and seek treatment for any side effects that do occur.
- Abscess
- Blood clots
- Digestive issues
- Fistula formation (abnormal connection between two body parts or tissues)
- General fatigue
- Infection
- Kidney problems (reduced kidney function)
- Lung problems, including pneumonia
- Severe bleeding
- Tissue perforation (a hole)
- Wounds that will not heal (dehiscence)
Experts say the most common peritonectomy and HIPEC side effects are bleeding and infection. Other side effects occur less frequently.
So patients should watch for side effects as directed by their care teams. But they should also understand the benefits of peritonectomy and HIPEC outweigh the risks for many qualified patients.
Common Questions About Mesothelioma Peritonectomy
What is the life expectancy for a peritonectomy patient with peritoneal mesothelioma?
How long does it take to recover from peritonectomy with HIPEC?
What are the chances of mesothelioma returning after peritonectomy with HIPEC?
What is the difference between cytoreductive surgery and peritonectomy?
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Dr. Francis Perry Wilson is the Director of the Clinical and Translational Research Accelerator at the Yale University School of Medicine. He specializes in nephrology and clinical research.
Amy Zappone brings nearly two decades of experience in education and research-based communication. At Mesothelioma.com, she translates complex topics into understandable resources that help patients and families make informed decisions.
