Robotic Cytoreductive Surgery & HIPEC

Robotic cytoreductive surgery is a modern surgical method that has been developing rapidly in the last 5-10 years. It is an innovative method and is applied for the treatment of neoplasms of the peritoneal cavity. The results of the surgery are quite promising, as after the surgery, the patient undergoes a special form of chemotherapy, intraperitoneal chemotherapy HIPEC. Thus, although for some years peritoneal carcinomatosis was considered a terminal disease, today more than 30% of patients are cured.

What is robotic cytoreductive surgery?

Robotic cytoreductive surgery is a modern method for the treatment of both primary and secondary peritoneal cancer. It is an extremely complex and long-lasting operation, as many surgical procedures of Surgical Oncology can be performed during the course of the procedure. During the operation, organs that are either affected or have an increased risk of being affected may be removed.

The complexity of the surgery requires the involvement of a robotic system. Precision of movements and elimination of physical hand tremor are necessary prerequisites for its success. In any case, performing the operation requires the surgeon performing the operation to be well trained and skilled in robotic systems.

When indicated, cytoreductive surgery can be combined with Hyperthermic Intraoperative Perioperative Intraperitoneal Chemotherapy (HIPEC). During HIPEC, a warm chemotherapeutic solution is administered inside the peritoneal cavity. The elevated temperature and direct administration are aimed at destroying the unseen disease as well.

For which conditions are robotic cytoreductive surgery and HIPEC chemotherapy indicated?

Initially, this surgical method was applied for the treatment of pseudomyxoma of the peritoneum. After its successful application, it is the treatment of choice for the treatment of neoplasms involving the peritoneum. Robotic cytoreductive surgery can be applied without HIPEC chemotherapy. However, absolute indication for the application of cytoreductive surgery and HIPEC are:

• colorectal adenocarcinoma
• Gastric cancer with peritoneal dissemination
• Small bowel cancer with peritoneal dissemination
• Peritoneal sarcomas
• Mesothelioma of the peritoneum
• Recto-colonic cancer with peritoneal dissemination
• Gynaecological cancers (e.g. ovarian cancer)

How is robotic cytoreductive surgery & HIPEC performed?

With the help of the robotic system in the first stage all the visible tumor is removed. Also, organs that have high rates of malignancy in the future may also be removed.

After the tumour is resected and cytoreductive surgery is completed, hyperthermic intraperitoneal chemotherapy (HIPEC) is started. In particular, the chemotherapeutic solution is administered through catheters into the peritoneal cavity. The temperature of the drug is 42-43o C, aiming to destroy (invisible) cancer cells. Direct administration helps to destroy the unseen disease and in this way the injected drug is gradually absorbed. This enables the administration of higher doses without the side effects of classical chemotherapy.

What are the advantages of cytoreductive surgery & HIPEC?

The advantages of cytoreductive surgery and HIPEC are many. Although it has been practiced since 1980, it is constantly improving in its practices and ensures higher rates of definitive treatment of peritoneal malignancy. More specifically, the advantages of this surgical method are as follows:

• Direct administration of the chemotherapeutic drug within the peritoneal cavity. This greatly increases the destruction of the unseen disease as well.
• Suitable method for treating malignancy that is localized only in the organs, without having spread to the bloodstream.
• Enhancing the effectiveness of the chemotherapy or radiotherapy to be applied subsequently. This is possible as cytoreductive surgery aims to remove more of the tumour.
• Saving key organs and preserving their function, ensuring a good quality of life for patients.

Post-operative course of a patient after cytoreductive surgery & HIPEC

The duration of this procedure can even exceed 14 hours. So, it is a long but complex surgical procedure. The patient’s hospitalization after the surgery is usually for 10-12 days. The patient should be monitored in the days following the surgery, thus ruling out the occurrence of any post-operative complications. Although rest is necessary, mobilisation is also recommended to prevent post-operative complications (e.g. thrombus formation).

 

Dr. Thalia Petropoulou is a Certified Specialist Consultant Lower Digestive Surgeon. She is the only holder of the International Robotic Colorectal Fellowship in Greece, and is fully trained in minimally invasive da Vinci surgical practices. Contact us for any questions you may have about robotic cytoreductive surgery & HIPEC.