Introduction:
Surgery is crucial to cancer treatment, particularly for individuals with solid tumors. Surgery is routinely used to treat people whose malignancies are localized when diagnosed. After a cancer diagnosis, cytoreductive surgery removes or destroys malignant tissue. In contrast to diagnostic operations, which may remove a portion of the tissue to confirm the presence and stage of the sickness, cytoreductive surgery for cancer takes a considerably more severe surgical approach, typically concluding in partial or whole removal of the organ of origin.
What Are the Types of Surgeries for Cancer?
The types of surgeries for cancer are as follows:
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Preventive surgery.
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Curative surgery.
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Cytoreductive Surgery.
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Supportive surgery.
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Restorative surgery.
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Debulking surgery.
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Palliative surgery.
What Is Cytoreductive Surgery for Cancer?
Cytoreductive surgery removes malignancy from the abdominal (peritoneal) cavity. It is used to eliminate all visible symptoms of malignancy in individuals with cancer that have spread within the abdominal cavity. Cytoreductive surgery and hyperthermic (heated) intraperitoneal chemotherapy (HIPEC) are frequently used. Hyperthermic intraperitoneal chemotherapy (HIPEC) targets any residual tiny cancer cells after cytoreductive surgery and destroys all visible cancer cells. Hyperthermic intraperitoneal chemotherapy (HIPEC) is commonly delivered in the operating room following cytoreductive surgery.
What Is the Role of Cytoreductive Surgery for Cancer?
A specific amount of normal and malignant tissue may be excised during cytoreductive surgery to obtain acceptable margins. The goal is to limit the risk of cancer cells surviving, which might lead to the disease returning, and to prevent future spread. The doctor should remove any lymph nodes around the tumor.
Due to various circumstances, including the lack of particular symptoms and inadequate screening to detect premalignant or early-stage illness, most cancer patients have advanced-stage disease and overt metastases. Therefore, the most successful treatment for these individuals is complete cytoreductive surgery combined with systemic chemotherapy.
Which Cancers Are Treated by Cytoreductive Surgery?
People with advanced cancer that has progressed to the abdomen are candidates for cytoreductive surgery. The following are the most prevalent malignancies that require cytoreductive surgery:
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Cancer of the ovaries.
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Cancer of the stomach.
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Cancer of the colon.
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Cancer of the appendix.
What Is Hyperthermic (Heated) Intraperitoneal Chemotherapy(HIPEC)?
The treatment of choice for peritoneal metastases from stomach, ovarian, or colorectal malignancies is hyperthermic intraperitoneal chemotherapy (HIPEC). Hyperthermic intraperitoneal chemotherapy, first described in animal experiments by Spratt in 1980 and known as a thermal transfusion infiltration system, represents a multimodal therapy increasingly used in managing peritoneal carcinoma and is now an integral part of the treatment of primary and secondary peritoneal tumors. It entails injecting cytotoxic chemicals into the peritoneal cavity at a high temperature (41 to 43 degrees Celsius) to increase absorption by neoplastic nodules. Nowadays, surgical cytoreduction combined with hyperthermic intraperitoneal chemotherapy (CRS / HIPEC) has radically altered the treatment of patients with malignant peritoneal tumors, significantly improving the prognosis of colorectal, appendicular, and ovarian tumors, as well as peritoneal mesothelioma.
What Are the Indications and Contraindications for Cytoreductive Surgery?
The indication for cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is as follows:
Indications:
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People suffering from synchronous peritoneal metastases.
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Low peritoneal cancer index (PCI) (ideally six; maximum of nine).
Contraindications:
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Signet ring cell histopathology in weakly cohesive carcinoma.
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People with a peritoneal disease that does not improve or worsen despite preoperative systemic intraperitoneal therapy.
How Is Cytoreductive Surgery Performed?
Cytoreductive surgery is also known as debulking therapy for peritoneal cancers and tries to remove all visible tumors from the abdominal cavity. In addition, HIPEC, a hot chemotherapeutic wash given to the abdomen area to eradicate any leftover cancer cells, is frequently performed after surgery.
Before the Procedure:
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Staging laparoscopy is usually performed before the cytoreductive surgery to identify the extent of sickness and avoid unnecessary laparotomies.
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Abdominal cavity exploration is achievable even in those who have undergone previous abdominal surgeries.
Procedure:
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During cytoreductive surgery, a midline incision from the xiphoid to the pubis enters the abdominal cavity.
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In cases of past abdominal surgery, the old abdominal incisions are removed.
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Regions damaged by the initial stage laparoscopy are meticulously resected even if they seem normal or consist of scar tissue because they may contain hidden active tumor cells that might lead to seeding metastases.
Tissue Dissection:
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Depending on the standard operating procedures of each surgical department and institution, tissue dissection can be conducted utilizing several instruments.
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Bipolar scissors are chosen for most surgical operations, while alternate methods and equipment, such as dissection with ball-tip electrocautery or an ultrasonic scalpel, are also often used.
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To hasten diaphragmatic stripping, ball-tip cautery, traction, and counter-traction can all be employed.
Neoadjuvant Intraperitoneal and Systemic Chemotherapy (NIPS) Or Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC):
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The response rate to systemic chemotherapy in individuals with peritoneal carcinomatosis is low, especially in malignancies of gastrointestinal origin.
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The conventional treatment strategy, neoadjuvant chemotherapy, did not significantly reduce peritoneal disease in these patients.
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The choice to resect prior incision sites after neoadjuvant intraperitoneal and systemic chemotherapy (NIPS) or pressurized intraperitoneal aerosol chemotherapy (PIPAC) Cytoreductive therapies may be more challenging, as these regimens have demonstrated higher effectiveness and conversion rates from unresectable to resectable disease.
What Are the Complications of Cytoreductive Surgery?
Treatments with cytoreductive surgery are more challenging to execute in individuals with scarring tissue, and sclerosing regions at peritoneal sites may impede identifying areas impacted by macroscopic tumors. In addition, due to adhesions or sub peritoneal inflammatory responses, surgical dissection may be more difficult in people who have previously received intraperitoneal chemotherapy, such as neoadjuvant intraperitoneal/systemic chemotherapy (NIPS) or pressurized intraperitoneal aerosol chemotherapy (PIPAC).
Conclusion:
Cytoreductive surgery is used on patients whose cancer has spread to their abdomen. During the surgery, the malignant tumors from the peritoneum area are removed by cytoreductive surgery in conjunction with hyperthermic (heated) intraperitoneal chemotherapy (HIPEC). This combination enables targeting both visible and microscopic tumors. The procedure is complex and should only be performed on people who have been extensively assessed as possible candidates by surgeons who have received extensive training.
