Is surgery palliative or potentially curative in peritoneal carcinomatosis?
In nearly 1/3 of the cases the entire treatment is potentially curative and patients may be long-term survivors having defeated cancer.
What is it dependent on a definitive treatment?
A definitive treatment depends on:
a) the capability of the patient to undergo a long-lasting and complex surgical intervention
b) the extent of the disease
c) the completeness of surgery
d) the aggressiveness of the tumor
Is the quality of life of the patient normal after such an extensive surgical operation?
The target of the entire treatment is to maintain the quality of life in previous level or to reduce it as less as possible.
When can the patient retain motor activity after such operations?
As soon as the patient is transferred to the ward may walk assisted by physiotherapists and the other personnel. In the beginning these activities are difficult because there are fluids parenterally administered as well as other drains (cannulas). Therefore, the assistance of the personnel is necessary and mandatory.
What is the rate of postoperative complications?
Approximately 30% of the patients are complicated during the immediate postoperative period. 17-20% of the recorded complications are severe and require re-intervention either radiological or surgical.
What is the rate of hospital mortality?
The hospital mortality does not exceed 1-2% and is comparable to the hospital mortality of any other major surgical operation.
What is the rate of complications from HIPEC?
HIPEC is not a dangerous chemotherapeutic method because the drugs that are instilled in the peritoneal cavity are absorbed very slowly in the systemic circulation. However, 8-9% of the patients exhibit myelotoxicity which is frequently mild and does not require specific treatment.
How long do the patients remain in the ICU?
The patients usually remain in the ICU for 24 hours. If the patient needs to be treated with early postoperative intraperitoneal chemotherapy (EPIC) or has severe postoperative problems for which must be monitored then he/she may need to remain in the ICU for 4-5 more days.
What is the length of hospital stay?
The length of hospital stay is approximately 15 days.
After discharge the patient is capable to eat regularly and have regular bowel movements?
Usually the patient eats regularly. In those cases that total gastrectomy has been performed the patient must consume more meals in smaller quantities. In these cases, the patient needs to receive B12 vitamin by injection once a month. In approximately 50% of the cases there is a protective stoma which means that the patient defecates temporarily irregularly. With less extensive operation the gastrointestinal tract continuity is reconstructed after 4-8 weeks and the patient defecates regularly. A permanent stoma is required in less than 5% of the patients.
Is systemic chemotherapy required after this treatment?
Many patients need to treated with systemic chemotherapy after this complex treatment but this depends on the aggressiveness of the disease which is assessed pathologically.
What is the follow-up of the patients?
The patients are followed-up regularly with CT-scan, hematological-biochemical examinations, and tumor markers, both from the surgical unit and the clinical oncologists.