About cytoreductive surgery and hyperthermic intraperitoneal chemotherapy
Three experts in oncology therapies from ACIBADEM clinics have recently took part in the “Medical and Scientific Days of BOI 2017”, a prestigious event for the medical oncology community from Romania and abroad. Within this session organized by the Oncology Institute „Prof. dr. Alexandru Trestioreanu” of Bucharest, Prof. Dr. Tamer Karsidag presented a paper focusing on a treatment method for advanced cancers, located especially in the peritoneal area. It is about cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, the benefits of which were described in detail by the top ACIBADEM surgeon who has been using this method for 15 years.
What is cytoreductive surgery and hypothermic intraperitoneal chemotherapy (HIPEC)?
Prof. dr. Tamer Karsidag: Cytoreductive surgery and hypothermic intraperitoneal chemotherapy (HIPEC) are methods applied to some patients with tumors disseminated in the abdominal cavity. If we remove as much of the tumor tissue as possible and apply high temperature chemotherapy, we increase the chances of fighting cancers in the abdominal area. I have been practicing this technique for 15 years, and it has been practiced around the world for 25 years.
What types of cancer can be treated using this method?
Prof. dr. Tamer Karsidag: In the beginning, the specialists applied these techniques only in cancers located in the peritoneal area, but then they started to use them in other types of conditions as well, such as gastric cancer. We are talking about an ample surgical intervention, lasting over 8 hours, sometimes even 14, while we clean the peritoneal area, the intestines, the gallbladder, the spleen, so it is an extremely industrious intervention. And after we clean the area, we apply high temperature chemotherapy, a method increasing the chances of annihilating as many malignant cells as possible.
Considering the duration, can it be said this is one of the most difficult interventions in cancer treatment?
Prof. dr. Tamer Karsidag: Yes, this intervention time is one of the most difficult in general surgery. It is impossible to do it with laparoscopy means, so it is a technique involving an open operating field, large incisions allowing us to clean the area and remove the cancer and metastases affected tissues.
What kind of equipment do you use for a better viewing of the treated area?
Prof. dr. Tamer Karsidag: In the beginning, we use classical apparatus, but after applying cytoreductive surgery, we use special devices to apply the chemotherapy medicines. Actually, technology helps us in injecting water heated with chemotherapeutical agents that destroy malignant cells, and then extract it.
What are the advantages for the patient and what stages of illness can be treated with cytoreductive surgery?
Prof. dr. Tamer Karsidag: With the help of these methods, we manage to expand the life expectancy of our patients with a period between 6 months to 4 years, and this is a clear benefit for the individuals the method is applied to. For some patients, such as those diagnosed with metastases, cytoreductive surgery and hyperthermic intraperitoneal chemotherapy are the last chance for treatment and survival. The method is relatively recent, it has been used for only 25 years, and those of us who practice it, we constantly work at developing it. Until now there are only a few global studies and now we integrate them in order to improve the solutions offered to these patients. If we select the cases that fit the best for this method and if we apply the most suitable techniques for the situation, we can obtain an increase in the life expectancy.
How is the recovery of patients taking place after such an intervention?
Prof. dr. Tamer Karsidag: For a good recovery, patients remain in the hospital for 22 days, and even more in some cases. So it is a long hospitalization period because there’s a high mortality risk, there are pains, complications might occur, but once this complicated period is over, patients can enjoy an increased life expectancy.
Are there risks in applying these methods?
Prof. dr. Tamer Karsidag: Cytoreductive surgery and hyperthermic chemotherapy involve risks, as well, there’s even a risk of death. But considering the serious medical condition of patients this method is applied to, the advantages are clear because we manage to increase the life expectancy to up to 4 years. The risk of death during the intervention reaches up to 10% because of the seriousness of the cases and of the intervention complexity, but if you look at the bigger picture, a longer life expectancy is an important result. The method is applied in several centers in the world and the patients are informed on the benefits and the risks of such an intervention.