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CRS-HIPEC : An Innovative Treatment for Peritoneal Cancers
Dr Melissa Teo , general surgeon and surgical oncologist at Mount Elizabeth Novena and Gleneagles Hospitals , explains how cytoreductive surgery ( CRS ) and hyperthermic intraperitoneal chemotherapy ( HIPEC ) may be used to effectively treat peritoneal cancers .
MELISSA TEO General Surgeon & Surgical Oncologist , Mount Elizabeth Novena and Gleneagles Hospitals
Dr Melissa Teo is a general surgeon and surgical oncologist at Mount Elizabeth Novena Hospital , Singapore . She has expertise in cancer of the colon and rectal , lower gastrointestinal cancers and surgical oncology , and has treated complex abdominal , pelvic and peritoneal cases in Southeast Asia .
You ’ re probably familiar with the idea of traditional chemotherapy being used to treat cancer . It involves the use of strong chemicals to kill cancer cells . There are also various chemotherapy drugs available , and depending on the patient ’ s condition , a doctor may choose to use a single drug or a combination of a few . In patients with cancers that have spread to the peritoneum ( abdominal lining ), heated chemotherapy can be delivered to the abdominal cavity after surgery to act on this lining and potentially kill and eradicate the cancers cells on the peritoneum .
This heated chemotherapy is known as hyperthermic intraperitoneal chemotherapy ( HIPEC ) and is performed during the same surgical setting after the complete removal of all visible tumours / cancers . This surgery is known as cytoreductive surgery ( CRS ).
What is cytoreductive surgery ( CRS ) and HIPEC ? Cytoreductive surgery ( CRS ) is a surgical procedure referring to the complete removal of all visible tumours / cancers and is particularly useful for cancers of the appendix , colon and rectum and ovary that have spread to involve the peritoneum . Whilst CRS has enabled the removal of all visible tumours / cancers , HIPEC is useful for addressing any microscopic cancer cells that may still exist within the abdominal cavity . This combined treatment has been shown to reduce the incidence of disease recurrence within the abdomen , leading to prolongation of survival and even cure in selected patients .
There are 2 stages to this combined treatment – CRS and HIPEC and both are performed whilst the patient is under general anaesthesia .
Stage 1 – Cytoreductive surgery ( CRS )
• An incision will be made in the patient ’ s abdomen
• The surgeon will then remove any visible cancerous tumours and diseased tissue
• CRS typically takes anywhere between 6 – 10 hours
Liver ( with surface tumours )
Tumours beneath left hemidiaphragm
Lesser omentum ( with tumours )
Gastroepiploic a . ( ligated branches )
Transverse colon
Left hemidiaphragm muscle
Peritoneum
Stage 2 – HIPEC procedure This is carried out once all the visible diseased tissue and tumours are surgically removed .
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