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). Together, surgery and HIPEC are the gold standard treatment for peritoneal mesothelioma.

01. Overview of Peritonectomy

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.

For mesothelioma patients, peritonectomy is usually followed by a heated chemotherapy treatment (HIPEC). Together, peritonectomy and HIPEC represent the gold standard in peritoneal mesothelioma treatment.

Will I Receive HIPEC After a Peritonectomy?

Research shows most patients go on to receive HIPEC after peritonectomy.

HIPEC stands for heated intraperitoneal chemotherapy. It consists of washing the abdominal cavity with a heated chemo fluid. HIPEC aims to kill cancer cells left behind by peritonectomy or CRS. Heating the chemo liquid and limiting it to the abdomen helps the drugs kill cancer cells more effectively.

CRS with HIPEC may be the most effective treatment for select peritoneal mesothelioma patients. Experts estimate it extends life by several years or more for selected patients.

02. What to Expect

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.

General Steps of a Mesothelioma Peritonectomy Procedure + HIPEC

Each patient’s peritonectomy experience will be unique. Procedure details can differ between surgeons and hospitals, but they generally share a few 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.

03. After a Peritonectomy

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 a total of 10 – 12 days. 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. Patients generally get back to most of their normal daily activities within one month of surgery.

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.

04. Benefits

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: Patients treated with peritonectomy and HIPEC have better survival rates than those treated with chemo.
  • 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. With peritonectomy and HIPEC, patients live about seven years. Patients wondering how this treatment may benefit them should discuss it with their doctors.

Survival Benefits of Peritonectomy + HIPEC Versus Chemotherapy for Peritoneal Mesothelioma

Peritonectomy + HIPEC

1-Year Survival Rate: 81%

Source: Journal of Clinical Oncology

Systemic Chemotherapy

1-Year Survival Rate: 47%

Source: Lung Cancer

05. Side Effects & Risks

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.

Potential Side Effects of Mesothelioma Peritonectomy + HIPEC

  • Abscess
  • Blood clots
  • Digestive issues
  • Fistula formation (abnormal connection between two body parts or tissues)
  • General fatigue
  • Infection
  • 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. And research indicates this treatment duo has a lower side effect rate than other common surgical procedures.

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.

06. Common Questions

Common Questions About Mesothelioma Peritonectomy

What’s the difference between cytoreductive surgery and debulking?

Cytoreductive surgery and debulking are essentially the same procedure. Many experts define them both as surgeries that aim to remove as many cancer cells as possible. Some online information claims debulking is less extensive, but medical literature largely disagrees with that claim.

What’s the difference between cytoreductive surgery and peritonectomy?

Peritonectomy is a type of cytoreductive surgery (CRS) that involves removing the abdominal lining. But CRS procedures may involve removing cancer tissue from additional areas like the ovaries, spleen, umbilical cord or uterus. Essentially, CRS can include peritonectomy and additional cancer-removing procedures.

How much does a peritonectomy procedure cost?

In medical literature, hospitals were paid around $60,000 – $65,000 for procedures that included peritonectomy and HIPEC. It is unclear how much of this treatment cost the patient covered versus insurance.