Cytorerductive Surgeries and HIPEC
CRS and HIPEC are techniques developed for the cure of Peritoneal Surface Cancers.
Peritoneum is a membrane that lines the inner surface of the abdominal cavity and envelopes the intra-abdominal organs and viscera. The peritoneum is made of two parts, the visceral and parietal peritoneum. The visceral peritoneum covers the internal organs and makes up most of the outer layer of the intestinal tract while the parietal peritoneum covers the abdominal cavity.
A cancer can arise in peritoneum primarily eg; Mesothelioma, Primary Peritoneal Malignancy and Ovarian Cancer or it may spread to the peritoneum from other sites like colon, rectum and stomach.
The Cytoreductive ‘Maximal Effort Surgery’ is a procedure that involves systematic, laborious and thorough physical removal of all visible tumour tissue that is deposited on the peritoneum. This, theoretically, reduces a stage IV disease to an RO (no residual tumor status) status with no macroscopic or visible disease. The microscopic disease (not visible to naked eye) that may be left behind after such a long surgery is then further eradicated by the HIPEC (Hyperthermic Intra-Peritoneal Chemotherapy).
During the HIPEC procedure, the surgeon will continuously circulate a heated sterile solution – containing a chemotherapeutic agent – throughout the peritoneal cavity, for a maximum of two hours. The HIPEC procedure is designed to attempt to kill any remaining cancer cells. The procedure also improves drug absorption and effect with minimal exposure to the rest of the body. In this way, the normal side effects of chemotherapy can be avoided.
It is the combination of both these modalities that makes this treatment highly effective in the treatment of peritoneal surface malignancies. Although this sort of treatment is still advanced and therefore, a novelty, fortunately, the required infrastructure, equipment and more importantly the expertise are all now available in Mumbai.