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Surgical Procedures

Cytoreductive Surgery and HIPEC




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Specialty Surgical Procedures and Research Protocal
The surgical oncologists, Dr's. Barone and Goldfarb, at OASD perform many specialty surgical procedures related to cancer diagnosis and treatment. Shown below and on Cytoreductive Surgery and Intraperitoneal Chemotherapy are some of these procedures and treatments.
  • Breast Cancer
    Sentinel Lymph Node Mapping: Technique used to identify the first lymph nodes which drain the area of the breast tumor. By identifying these nodes special techniques are used to identify microscopic tumor cells in the lymph node that may be missed on routine techniques.

    To learn more about our breast care division, Comprehensive Breast Care of San Diego, please visit our new website.

  • Colon Cancer
    Surgery is the primary mode of treatment for colon cancer. In instances where the cancer has already spread to other areas such as the liver,treatment with chemotherapy prior to surgical removal is sometimes recommended. In some cases where the cancer has spread to the liver,surgical removal of the colon tumor combined with placement of an implantable liver infusion pump to treat the liver with regional chemotherapy after surgery is performed. At times where only a few tumors are found in the liver, surgical removal of the tumors or parts of the liver is carried out to remove all visible liver nodules combined with removal of the colon tumor.

  • Esophageal Cancer
    Preoperative chemotherapy and radiation treatment is administered to decrease tumor size before undergoing surgery. This combination treatment appears to increase overall survival.

  • Liver Cancer
    • Cryoablation: Freezing tumors within the liver.
    • Radiofrequency Ablation: Heat killing of tumors within the liver.
    • Regional Chemotherapy: Continuous administration of high doses of chemotherapy via a catheter placed directly into the liver, resulting in less chemotherapy side effects elsewhere in the body.

  • Melanoma
    • Sentinel Lymph Node Mapping: Technique used to identify the first lymph nodes which drain the area of the breast tumor. By identifying these nodes special techniques are used to identify microscopic tumor cells in the lymph node that may be missed on routine techniques.
    • Hyperthermic Isolated Limb Perfusion: Continuous delivery of high doses of chemotherapy in conjunction with heat to an arm or leg for local tumor control.

  • Rectal Cancer
    • Sphincter Preserving Procedures: Local removal of cancer through the anus.
    • Mesorectal Resections: Nerve preserving surgery to maintain bladder and erectile function.

  • Peritoneal Surface Malignancies
    • Appendix:  Tumors arising from the appendix can lead to DPAM (disseminated peritoneal adenomucinosis) or PMCA (peritoneal mucinous carcinomatosis), the malignant form of appendiceal cancer.  These tumors if they burst or perforate will disseminate cells throughout the abdomen and subsequently result in adenomucinosis or carcinomatosis.  These tumors are best treated with cytoreductive procedures and heated intraperitoneal chemotherapy (HIPEC)

    • Colorectal:  30-50% of patients with cancer arising from the colon or rectum will have spread to the abdominal cavity alone.  Patients with mucinous carcinoma may be good candidates for cytoreductive surgery and HIPEC as well as those patients who have had perforation of their colon carcinoma found at the initial surgery.

    • Gastric carcinoma:  Peritoneal spread and recurrence is commonly seen in gastric cancer.  60% of the patients with more advanced cancer of the stomach despite what is thought to be a curative resection will have peritoneal recurrence.  20-40% of all gastric cancer patients die as a direct result of peritoneal dissemination.   Recent European studies have shown improved survival and decrease in peritoneal spread using HIPEC at the time of the initial surgery. Similar improvement in eradicating peritoneal disease has been reported in some patients who recur with limited peritoneal disease after their primary resection using cytoreductive surgery and HIPEC.

    • Peritoneal mesothelioma:  Is a rare disease that usually affects the lining of the chest, but also can involve the lining of the abdominal cavity.  Peritoneal mesothelioma has several histologic types.  Some have relatively benign behavior and may not result in death of the patient for many years.  However, more aggressive mesotheliomas may show spread to lymph nodes and peritoneal and intestinal surfaces and can lead to death. Peritoneal mesothelioma is amenable in most cases to initial cytoreductive surgery and HIPEC and also postoperative intraperitoneal and systemic “intravenous” chemotherapy.  Occasionally it is recommended that intravenous chemotherapy be delivered prior to surgery. This is done to decrease the size of the tumor in order to make the cytoreductive surgery easier.  Some histologic types of peritoneal mesothelioma are not considered for cytoreductive surgery because of their poor prognosis.

    • Ovarian carcinoma:  Ovarian cancer is the sixth most common cancer of women worldwide and is responsible for the greatest number of deaths from all gynecological malignancies.  Patients with Stage III/IV disease who undergo cytoreductive surgery followed by intravenous chemotherapy can achieve complete response rates of 70-80%.  However, only 20-40% of the patients who undergo second look surgery after completing this chemotherapy are found to be free of disease at the second look surgery. Of the 20-40% found to have no disease at the time of second look surgery, 50-70% of these patients will recur within five years.

    • Most of the recurrences found in ovarian cancer are confined to the abdominal cavity.  This means that there are microscopic cells remaining that are not seen at the time of the second look surgery.  Therefore we strongly recommend at the time of the second look surgery or if one has been first treated with neoadjuvant chemotherapy to reduce tumor load prior to the initial surgery, that HIPEC be performed as well as EPIC (early postoperative intraperitoneal chemotherapy).  We have found using HIPEC that more patients are being cured of the disease at five years and there is less chance of recurrence in those patients who present with advanced tumors (Stage III/IV).

    • Uterine Carcinoma:  Cancers that arise from the uterus are called endometrial carcinoma.  Most of these tumors are best treated with radical hysterectomy, radiation, and chemotherapy.  Although there are some types of endometrial cancers when they recur will recur primarily in the abdomen. Some of these patients are  candidates for cytoreductive surgery and HIPEC. Sarcoma:  These are tumors that can originate from the gastrointestinal tract such at GIST (gastrointestinal stromal tumor), or from the uterus (leiomyosarcoma).  These tumors when they have spread to the peritoneum can be treated with cytoreductive surgery and HIPEC.

  • Soft Tissue Cancer (Sarcoma):
    • Limb preserving surgery is accomplished by using chemotherapy and radiation before surgery to decrease the size of the tumor so that amputation can be avoided.
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