28 February 2023
The Department of Surgical Oncology, Fortis Mohali, successfully treated a 42-year-old woman suffering from Pseudomyxoma Peritonei (PMP) cancer Cancer of the abdomen through Cytoreductive Surgery (CRS) and HIPEC Surgery (Hyperthermic Intraperitoneal Chemotherapy). The case attains significance as PMP cancer is extremely rare with an incidence rate of approximately 1-2 per million a year.
The team of doctors led by Dr Jitender Rohila, Consultant, Surgical Oncology and Robotic surgeon, Fortis Hospital Mohali, treated the Patient. CRS HIPEC has been established as the gold standard surgical treatment for PMP cancer. It is a combination of complex surgery and intra abdominal chemotherapy to eradicate advanced abdominal tumors. Cytoreductive Surgery (CRS) includes removal of all sites of cancer within the abdominal cavity, while HIPEC Surgery involves administering heated chemotherapy in the abdomen inside the operation theatre after ensuring complete CRS.
The Patient had severe abdominal swelling, changes in bowel habits and loss of appetite. She had also undergone a surgery for suspected ovarian cancer (uterus, both ovaries and appendix had been removed) three months ago at another hospital. Diagnostic reports revealed a mucinous tumor with origin from the appendix. Post which, the patient finallyapproached Dr Rohila at Fortis Mohali last month where medical examinations and the CT scan showed mucinous ascites (jelly-like substance in the abdomen) and tumor deposits in the whole abdominal cavity, suggestive of PMP cancer. Following discussions with the Tumour Board, Dr Rohila conducted CRS and HIPEC Surgery on the Patient.
Discussing the case, Dr Rohila, said, “It was a complex surgery which included bowel resection and removal of the tumour from the liver and intestines. The complete cytoreduction took around 8 hours. After the tumour was removed, HIPEC was performed for 90 minutes. The Patient had a smooth post-operative recovery and was discharged 10 days after the surgery. She has recovered completely and leading a normal life today.”
Explaining the CRS HIPEC procedure, Dr Rohila, said, “CRS HIPEC is used to treat cancers which have spread to the peritoneum from cancers of appendix, large intestine (colon & rectum), stomach, ovary or the cancers that develop from the peritoneum like pseudomyxoma peritonei, malignant peritoneal mesothelioma and primary peritoneal cancers. CRS HIPEC is a major surgical procedure and requires trained surgeons, experienced teams of anesthesia and ICU critical care team, experienced medical oncology team to manage chemotherapy-related complications, expert radiology team and oncopathology team for the correct diagnosis including type, stage and grade of cancer; an intervention radiology facility to manage post-operative complications, and a rehabilitation team to ensure smooth and early recovery.”