Cytoreductive surgery (CRS) for pseudomyxoma peritonei (PMP) is a complex operation with the aim of removing all visible tumours, affected tissue and entire organs. The National Institute for Health and Care Excellence (NICE) guidelines¹ recommends the Sugarbaker technique and defines the operation as radical.
The Sugarbaker technique was developed by Dr Paul Sugarbaker at the Washington Cancer Institute. It involves complete surgical tumour removal (complete cytoreduction) combined with intraoperative heated chemotherapy directly into the abdomen, followed by postoperative intraperitoneal chemotherapy. The operation takes about 10 hours to complete and includes:
• removal of the right hemicolon, spleen, gall bladder, greater omentum and lesser omentum
• stripping of the peritoneum from the pelvis and diaphragm
• stripping of tumour from the surface of the liver
• removal of the uterus and ovaries in women
• removal of the rectum in some cases
The operation can last anywhere from six to over 15 hours. Some patients have a colostomy or an ileostomy as a result of the surgery. This ostomy or stoma may be temporary or permanent, depending on individual circumstances. A temporary stoma allows the bowel to heal after resection and can be reversed in a subsequent operation.
After the surgery, before the patient is closed up, a perfusion² of heated intraperitoneal chemotherapy (HIPEC). A chemotherapy drug called Mitomycin-C is typically used to kill cancer cells that are not visible to the human eye. HIPEC may add another 90-120 minutes to the surgical procedure. Some specialists, though not all, continue intra-abdominal chemotherapy for a period of between three and five days after the operation. CRS and HIPEC is a major procedure with a long recovery time. Even without complications, patients typically stay in hospital for at least two weeks afterwards.
It can take up to a year to physically recover from the operation although many patients make a quicker recovery with some returning to work within eight weeks or so.
¹Complete cytoreduction for pseudomyxoma peritonei (Sugarbaker technique)
NICE interventional procedures guidance [IPG56], https://www.nice.org.uk/guidance/IPG56, accessed September 2019
Perfusion is the term used to describe the passage of fluid through tissue.
Written by: A Brook
Reviewed by : Dr G Morgan