Cytoreductive Surgery in Delhi, India

Cytoreductive surgery is an aggressive form of surgical procedure that aims to remove all visible tumours from the abdominal cavity. In selected patients, cytoreductive surgery is performed along with Hyperthermic Intraperitoneal Chemotherapy (HIPEC), which is the administration of heated chemotherapy agents in the operating room after the completion of cytoreductive surgery.

The HIPEC can be performed in an open/closed method. CRS and HIPEC work together to eradicate and kill all visible and microscopic diseases in the abdominal cavity. This procedure has been shown to have a significant survival advantage in a selected population of patients.

Who Are the Best Candidates for Cytoreductive Surgery?

Cytoreductive surgery has been shown to be beneficial in patients in whom cancers arising from the ovary gastrointestinal organs like the colon, appendix, stomach, and mesothelium have spread in the abdominal cavity and peritoneum. However, this is when the cancer is confined to the abdominal cavity only and is resectable.

Who Should Not Consider Cytoreductive Surgery?

The following conditions can prove to be contraindications of cytoreductive surgery:

• Patients in whom the disease has spread beyond the abdominal cavity.
• Patients in whom the abdominal disease is unresectable.
• Patients with extremes of age, serious comorbidities and poor general condition (however, this is subjective, and patient eligibility is decided after proper clinical evaluation by the doctor).

How to Prepare for Cytoreductive Surgery?

Cytoreductive surgery is a complex surgical procedure. Due to its complex nature, the surgeon collects all the details about the patient's medical history along with the stage of cancer and type of tumour beforehand. Then, the doctor may perform several tests and scans. These may include blood and urine tests, CT scans, MRI scans, X-rays, ultrasound, and more. If the patient has been on certain medications like – blood thinners, antiplatelet agents, medications for diabetes and heart conditions- doses of these medications might have to be altered or stopped. These changes are to be made only by the respective treating doctor.

The day before the surgery, one might need to get bowel preparation by having osmotic agents, laxatives or enema- depending on the tumour type and the surgery planned. Certain dietary changes might also be recommended by the doctor. The doctor may also prescribe some antibiotics before the surgery in some cases. Apart from this, other preparations for cytoreductive surgery may require the following:

• Leave all the jewellery at home before going to the hospital.
• Quit smoking or drinking alcohol before the surgery.
• Discuss all medications that you have been regularly taking, especially blood thinners- and if any modification is needed with the doctor.
• Don't eat or drink for hours before the surgery as per the instructions given by the specialist.

How Is Cytoreductive Surgery Performed?

The cytoreductive surgery might be performed with or without hyperthermic intraperitoneal chemotherapy (HIPEC).

For cytoreductive surgery, the surgeon makes an incision and accesses the abdominal cavity. The surgeon then removes all the visible tumours from the primary site as well as the sites to which it has spread.

In some cases, if needed, the surgeon may also remove organs that have been involved by cancer, like the gallbladder, spleen, lining of the abdominal wall, and part of the small or large intestine. After the visible tumour is removed, microscopic cancer cells are targeted by HIPEC (if indicated).

During the HIPEC, the chemotherapy agents are heated to a temperature between 41 to 43 degrees Celsius and the agents are instilled into the abdominal cavity for approximately 90 minutes. The chemotherapy agents and the timing may differ for each patient or condition. The heated chemotherapy circulates inside the abdominal cavity and acts to eradicate microscopic disease.

Once the period is over, the chemotherapy solution is removed from the abdominal cavity, and the abdomen is closed with sutures.

Possible Complications

Like any other major surgery, there are some risks associated with cytoreductive surgery, including bleeding, infection, and reaction to anaesthesia. Other complications that may occur due to HIPEC include:

• Kidney failure
• Higher chances of leak of anastomosis
• Myelosuppression
• Prolonged Postoperative Ileus
• Higher chances of infection

Care after the Surgery

After the cytoreductive surgery, the patients may need to be monitored in the intensive care unit for around 3-5 days. In some cases, the stay could be longer (depending on the postoperative condition and recovery). The recovery period for the surgery is usually one to two months. Once discharged from the hospital, the doctor may provide instructions in the postoperative period to ensure a speedy recovery. The instructions may be as follows:

• Avoid strenuous physical activities for four to six weeks.
• Take all the medications on time as prescribed by the doctor.
• Maintain a healthy lifestyle.
• Eat a nutritious diet.
• Take vitamin A and vitamin C supplements.
• Follow-up tests and appointments after the surgery.

Review

Reviewed by Dr. Kanika Batra Modi, Senior Consultant - Gynaecologic Oncology