Peritoneal cancer - Peritonectomy Services NSW

What is peritoneal cancer?

The peritoneum is a thin membrane which lines the abdominal cavity and covers the organs inside the cavity.(1)
Peritoneal cancer includes:

  • Primary peritoneal cancer (PPC) - a rare cancer which starts in the cells of the peritoneum.(2)
  • Peritoneal carcinomatosis (PC) - cancer which starts in another part of the body, such as the ovary or bowel, and spreads to the peritoneum.(3)


Peritoneal cancer treatment

Some patients with peritoneal cancer may be suitable for peritonectomy, also known as cytoreductive surgery. The aim of this surgery is to completely remove all peritoneal cancer visible to the naked eye (macroscopic disease).(4-6)
Chemotherapy is then given into the abdominal cavity to kill any remaining cancer cells not visible to the naked eye (microscopic disease). Generally, chemotherapy is given at the time of surgery as heated intraperitoneal chemotherapy (HIPEC).(6,7) Some patients also have early post-operative peritoneal chemotherapy (EPIC).(8)

This treatment can be considered for treating peritoneal cancer from (9):

  • appendiceal cancer
  • colorectal cancer 
  • peritoneal mesothelioma
  • ovarian cancer
  • pseudmyxoma peritonei (pmp)(10)
  • Others *

Peritonectomy is a highly invasive surgical procedure and the benefits of such surgery need to be carefully weighed against the possible complications that can occur.(5-11)

* Treatment Should be conducted under Human Research Ethics Committee oversight

Availability of multidisciplinary cancer care team

Patients with peritoneal cancer may have one or more types of treatment, including surgery, chemotherapy and radiotherapy.(8,12)

The involvement of a multidisciplinary cancer care team is required to create a patient treatment plan. This team brings together health care professionals from different specialties to discuss a patient's cancer diagnosis and staging, and their treatment options. It also enhances communication and care co-ordination between the specialists
involved in a patient's care.(5-13) 

Australian and international studies show that patients whose care is overseen by a multidisciplinary cancer care team experience better outcomes after cancer treatment.(14)

Actions for Health Professionals

Patient referral

Patients with a peritoneal cancer, for whom a multidisciplinary cancer care team has established that peritonectomy is a valid treatment option, should be referred to one of the two NSW peritonectomy services listed below.

Involvement of a multidisciplinary cancer care team early in the cancer journey is recommended to ensure optimal assessment, care, and outcomes.

The Canrefer website allows you to find cancer specialists who are MDT members, and has information about cancer services, optimal care pathways, and patient resources.

Smoking cessation support

Evidence suggests that tobacco cessation following cancer diagnosis improves survival. It also reduces treatment-related complications.[13–14] Health professionals should discuss tobacco use with all patients and provide appropriate cessation support.

List of NSW peritonectomy services 

Local health district

Hospital

Multidisciplinary Cancer care team

South Eastern SydneySt George HospitalSt George Hospital Peritonectomy MDT

Sydney

Royal Prince Alfred Hospital

Royal Prince Alfred and Lifehouse  Peritonectomy MDT


References 

  1. Victoria CC. Peritoneal cancer [Available from: Zttps://www.cancervic.org.auicancer-informationjtypes-of-cancer/peritoneal cancerlperitoneal-cancer-overview.html.1. 
  2. Jaaback K, Ludeman L, Clayton N, Hirschowitz L. Primary peritoneal carcinoma in a UK cancer center: comparison with advanced ovarian carcinoma over a 5-year period. International Journal of Gynecologic Cancer. 2006;16(Suppl 1):123-8.
  3. Coccolini F, Gheza F, Lotti M, Virzi 5, lusco D, Ghermandi C, et al. Peritoneal carcinomatosis. World journal of gastroenterology: WJG. 2013;19(41):6979.3
  4. NSW CC. Peritonectomy for peritoneal mesothelioma [Available from: https://www.cancercouncil.com.auiperitoneal-mesothelioma/active-treatmentiperitonectomyi.
  5. Mehta SS, Bhatt A, Glehen 0. Cytoreductive surgery and peritonectomy procedures. Indian journal of surgical oncology. 2016;7(2):139-51.
  6.  Liu Y, Endo V. Fujita T, Ishibashi H, Nishioka T, Canbay E, et al. Cytoreductive surgery under aminolevulinic acid-mediated photodynamic diagnosis plus hyperthermic intraperitoneal chemotherapy in patients with peritoneal carcinomatosis from ovarian cancer and primary peritoneal carcinoma: results of a phase I trial. Annals of surgical oncology. 2014;21(13):4256-62.
  7. Spiliotis J, Halkia E, Boumis V, Vassiliadou D, Pagoulatou A, Efstathiou E. Cytoreductive surgery and HIPEC for peritoneal carcinomatosis in the elderly. International journal of surgical oncology. 2014;2014.
  8. Yonemura Y, Canbay E, Endou Y, Ishibashi H, Mizumoto A, Miura M, et al. Peritoneal cancer treatment. Expert opinion on pharmacotherapy. 2014;15(5):623-36.
  9. Glockzin G, Schlitt Hi, Piso P. Peritoneal carcinomatosis: patients selection, perioperative complications and quality of life related to cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. World journal of surgical oncology. 2009;7(1):5.
  10. Qu Z-B, Liu L-X. Management of pseudomyxoma peritonei. World Journal of Gastroenterology: WIG. 2006;12(38):6124.
  11. Sugarbaker PH. Peritoneal carcinomatosis: principles of management: Springer Science & Business Media; 1996.
  12.  Farrell R. Is peritonectomy and hyperthermic intraperitoneal chemotherapy a new standard of treatment for advanced epithelial ovarian cancer? Australian and New Zealand Journal of Obstetrics and Gynaecology. 2019.
  13. Australia C. Multidisciplinary care: Australia Government; [Available from: https://canceraustralia.gov.au/clinical-best-practiceimultidisciplinary-care.
  14. Strandby RB, Svendsen LB, Fallentin E, Egeland C, Achiam M. The multidisciplinary team conference's decision on m-staging in patients with gastric-and gastroesophageal cancer is not accurate without staging laparoscopy. Scandinavian Journal of Surgery. 2016;105(2):104-8.
  15. Karam-Hage M, Cinciripini PM, Gritz ER. Tobacco use and cessation for cancer survivors: an overview for clinicians. CA: a cancer journal for clinicians. 2014;64(4):272-90.
  16. Warren GW, Sobus S, Gritz ER. The biological and clinical effects of smoking by patients with cancer and strategies to implement evidence-based tobacco cessation support. Lancet Oncol. 2014;15(12):e568-80.
  17. Florou AN, Gkiozos IC, Tsagouli SK, Souliotis KN, Syrigos KN. Clinical significance of smoking cessation in subjects with cancer: a 30-year review. Respiratory care. 2014;59(12):1924-36.
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