Oncological Surgery

What is Peritoneal Carcinomatosis?

Peritoneal carcinomatosis (PC) is the spread of cancer cells throughout the abdominal cavity, which is lined by the peritoneum, a thin membrane surrounding the abdominal organs.

This condition commonly occurs in patients with advanced gastrointestinal and gynaecological cancers, as well as in those with primary peritoneal tumours. It is considered a manifestation of widespread disease and, if left untreated, is associated with a poor prognosis, with a life expectancy of less than six months.

In recent years, major advances in Peritoneal Oncology have enabled a more aggressive therapeutic approach through the combination of cytoreductive surgery (CRS), Hyperthermic Intraperitoneal Chemotherapy (HIPEC), and systemic chemotherapy. In selected patients, this strategy has been shown to improve survival and quality of life.

Oncological Conditions Associated with Peritoneal Carcinomatosis

Peritoneal carcinomatosis may arise from three main groups of tumours:

Primary Peritoneal Tumours

• Peritoneal mesothelioma

• Primary peritoneal cancer

Intraperitoneal Tumours

• Gastrointestinal cancers

• Gynaecological cancers

Extraperitoneal Tumours

• Breast cancer

• Lung cancer

• Melanoma

Treatment is tailored according to the origin of the tumour and is not always surgical.

Symptoms of Peritoneal Carcinomatosis

Symptoms are often non-specific, and in the early stages the disease may be completely asymptomatic. In many cases, it is only identified during surgery for the primary tumour.

Common Symptoms

• Abdominal swelling or distension, sometimes associated with tumour growth and fluid accumulation (ascites)

• Loss of appetite

• Weight loss

• Nausea and vomiting in the context of cancer

• Abdominal pain

• Fatigue

• Shortness of breath caused by the accumulation of large volumes of abdominal fluid

Treatment of Peritoneal Carcinomatosis

At the Peritoneal Carcinomatosis Unit of Quirónsalud Torrevieja Hospital, patients receive multidisciplinary care covering every stage of their disease.

Diagnosis

Peritoneal carcinomatosis is diagnosed using:

• Staging laparoscopy

• Advanced radiological assessment

Personalised Multimodal Treatment

Each patient receives an individualised treatment plan designed by the Oncology Platform multidisciplinary team.

Radical Surgical Treatment: CRS + HIPEC

Where appropriate, treatment includes:

• Cytoreductive surgery (CRS) to remove visible disease

• Hyperthermic Intraperitoneal Chemotherapy (HIPEC) administered during the same operation

This specialised programme is delivered by a surgical team with more than 20 years of experience.

Precision Oncology and Genetic Profiling

For aggressive tumours, chemotherapy-resistant disease, or progressive cancers, tumour samples may undergo:

• Genomic analysis

• Transcriptomic analysis

These studies help guide personalised treatment based on the specific genetic alterations present within each tumour.

The Peritoneal Carcinomatosis Unit, established in 2003, has performed more than 300 HIPEC procedures, while assessing and treating over 50 patients annually.

Surgery for Peritoneal Carcinomatosis

Treatment consists of two complementary stages performed during the same operation:

1. Cytoreductive Surgery (CRS)

2. Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

What is HIPEC?

HIPEC combines radical surgery to remove all visible tumour deposits with the circulation of heated chemotherapy directly within the abdominal cavity during the same surgical procedure.

This approach aims to destroy microscopic residual disease and cancer cells that cannot be seen by the surgeon, helping to leave the abdominal cavity free of detectable tumour and improving disease control.

Originally developed by Dr Sugarbaker, HIPEC has demonstrated significant effectiveness in selected cancers, achieving five-year disease-free survival rates exceeding 50% in some cases of colorectal and ovarian cancer.

When is Surgery Indicated?

CRS and HIPEC may be considered in patients with:

• Peritoneal carcinomatosis

• Good overall physical condition

• No distant metastases

• Disease that can be completely removed through surgery

The precise indications depend on tumour type, disease extent and the expected benefit of HIPEC in long-term disease control.

Tumours Commonly Treated with CRS + HIPEC

• Primary peritoneal tumours

• Colorectal cancer

• Gastric cancer

• Appendiceal cancer

• Ovarian cancer

• Endometrial cancer

• Desmoplastic small round cell tumour of the retroperitoneum

Surgical Procedure

Treatment combines extensive tumour removal with heated chemotherapy administration and is performed under general anaesthesia with continuous monitoring.

Step 1: Exploration and Disease Assessment

The surgeon accesses the abdominal cavity through a midline incision and evaluates tumour spread using the Peritoneal Cancer Index (PCI), while obtaining tissue samples and biopsies.

Step 2: Removal of the Primary Tumour

When present, the primary tumour is removed with appropriate surgical margins together with its draining lymph nodes.

Step 3: Cytoreductive Surgery

The affected peritoneum (peritonectomy) and all visible tumour deposits are removed with the aim of achieving complete macroscopic cytoreduction, leaving no disease visible to the naked eye.

Heated Intraperitoneal Chemotherapy Perfusion

Following cytoreductive surgery, chemotherapy is circulated throughout the abdominal cavity at a rate of up to 2 litres per minute for approximately 30 to 90 minutes.

A specialised perfusion system continuously heats the chemotherapeutic agent to 40-42°C before it enters the abdominal cavity. Temperature is carefully monitored and regulated throughout the procedure.

This combination of high-dose local chemotherapy and hyperthermia offers several advantages:

• Destruction of microscopic residual tumour cells

• Improved local disease control

• Enhanced chemotherapy penetration into tumour tissue

• Direct cytotoxic effects from heat

• Ability to administer higher drug concentrations than would be possible through intravenous treatment

Preparing for Surgery

Before surgery:

• All patients are reviewed by the Anaesthetics Department.

• Fasting for at least six hours is recommended (eight hours for solid food).

• Any regular medication should be discussed with your medical team.

Common Pre-operative Tests

• Blood tests

• Chest X-ray

• Electrocardiogram (ECG)

A comprehensive pre-anaesthetic assessment is also required.

Recovery and Post-Operative Care

Your medical team will provide specific guidance regarding:

• Diet

• Physical activity

• Follow-up appointments

If you develop fever or unusual bleeding, you should seek immediate medical attention through the Emergency Department.

Life Expectancy and Outcomes

Thanks to advances in treatment, patients with peritoneal carcinomatosis can now achieve five-year survival rates exceeding 40%, often with an excellent quality of life. Without treatment, survival outcomes are significantly poorer.

Specialists in Peritoneal Carcinomatosis Treatment in Torrevieja

The Peritoneal Carcinomatosis Unit is led by Dr Pedro Bretcha, Head of Surgery, a pioneer in Spain in the application of HIPEC. He is also a member of the Executive Committee of the Spanish Group for Peritoneal Surgical Oncology (GECOP) and serves as an advisor to the Peritoneal Oncology Section of the European Society of Surgical Oncology (ESSO).

For further information about our services, please contact us using the enquiry form and a member of our team will respond as soon as possible.