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Peritonectomy

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Peritonectomy

Waikato Hospital has been providing cytoreductive surgery with heated intraperitoneal chemotherapy since 2008.  To date, Waikato has treated over 200 patients, and the technique has been refined to a dedicated team of surgeons, anaesthetists, oncologists, theatre nursing staff, perfusion equipment and personnel, perioperative nursing care, dieticians and pathologists.  Waikato is one of 6 hospitals in Australia and New Zealand performing cytoreductive surgery with HIPEC, and are part of the ANZ Peritoneal Malignancy Collaboration, supporting research and the progression of this field of expertise in Australasia.

For more information on the surgeons currently performing cytoreductive surgery with HIPEC in the Waikato, see our Our team.

Indications

Waikato Hospital provides cytoreductive surgery with heated intraperitoneal chemotherapy for the following indications:

  • Appendiceal cancer
  • Colorectal cancer with isolated peritoneal metastases (PCI <15)
  • Malignant peritoneal mesothelioma
  • Ovarian cancer
  • Pseudomyxoma peritonei

Referrals and enquiries can be emailed to peritonectomy@waikatodhb.health.nz.  There is an MDM form to kindly complete with the required details which can be requested through the email above. The deadline for discussion is the Monday prior. 

Discussions occur on Wednesday morning at 7.40am and the outcome of the discussion will be emailed to the referring clinician.  Please ensure all relevant notes and scans are made available via email and the Waikato PACS system (radiology) for review prior to MDM.

Clinic appointments, if appropriate, will be scheduled within 2 to 4 weeks of referral, depending on the urgency required for surgery.  Time frames typically expected for surgery depend on the indication, volume of disease, and symptoms experienced by the patient.  We would like to know if your patient is worsening, or you have any other concerns, via the email above so that we can increase their priority for treatment.

Other options for treatment include a referral to private, for patients who are insured.  Referrals can be sent to Surgeons on Clarence at the email info@surgery.co.nz

If possible, patients are scheduled for a pre-anaesthetic assessment clinic on the day of their consultation in Waikato.  In some cases, an anaesthetic assessment is requested at the referring hospital which we may request.  Patients are booked in to come on the day prior to surgery, and will be visited by the treating team (surgeon, anaesthetist, colorectal CNS, charge nurse, stoma therapist).

The staging investigations required for work up depends on the indication, but would typically include tumour markers (CEA, CA19-9, CA125), diagnostic laparoscopy with biopsy (or image guided core biopsy) and assessment of PCI (attached to article below), full staging CT scan and colonoscopy.  A PET scan is essential for patients with colorectal cancer.

After surgery, patients are discussed at a pathology MDM where the pathology is discussed and the slides are reviewed.  In some instances, adjuvant chemotherapy is recommended and a letter will go to the referrer to request a review from oncology at the referring institution. 

Surveillance guidelines are otherwise 4 monthly CEA, CA19-9 and CA125, except for colorectal cancer where CEA alone is tested.  CT scans are suggested at 1, 2, 3 and 5 years.  Recurrences may be suitable for repeat surgery with HIPEC, and we would appreciate a referral for discussion if a patient we have treated has had recurrent disease diagnosed.

Waikato maintains a prospective database of patients for audit and research, to ensure that the highest level of care can be provided to our patients.  Waikato is also part of the ANZ Peritoneal Malignancy Collaboration, contributing to research and the development of consensus guidelines for the management of peritoneal disease.  A link to our data and outcomes can be found below:

Cytoreductive surgery with heated intraperitoneal chemotherapy is offered to patients with disease localised within the peritoneal cavity.  The primary site of origin could include the appendix, colon or rectum, ovary or malignant mesothelioma.

The peritoneal cavity is a space within the abdomen that is typically insufflated when one has a laparoscopy.  The peritoneum is a layer of tissue which covers the underside of the abdominal wall, diaphragm and coats the organs.  Disease within the peritoneal cavity tends to sit on the peritoneum and abdominal organs, rather than infiltrate into them and spreading to the lymph glands or elsewhere in the body, thereby allowing its removal.

Peritonectomy

The aim of cytoreductive surgery is to remove all visible disease.  To do this, the peritoneum is stripped away and any organs which contain disease are removed.  This may include the spleen, part of the stomach, omentum, gallbladder, large intestine, uterus and ovaries. A small amount of the small bowel may be able to be removed but not all, and disease located around the main trunk of blood supply to the liver can also be difficult to remove in entirety.  Once all visible disease is removed, heated chemotherapy is instilled into the abdominal cavity by a perfusionist for 90 minutes, which kills any remaining viable tumour cells.

To date, Waikato has performed over 200 procedures and the operation is performed by one of 5 surgeons, working in pairs for patients with high volume disease.  The majority of patients have been treated for pseudomyxoma peritonei which arises from the appendix, but an increasing number are offered surgery for colorectal cancer where there is limited peritoneal disease and no disease elsewhere in the body.

Surgery is a major undertaking and requires a specialised multidisciplinary team, versed in the procedure, post operative care and interpretation of pathology and follow up.  The operation takes 9 hours on average to complete and patients are transferred to the high dependency unit post operatively for 2 days.  Recovery in hospital is expected to take up to around 2 weeks, before patients are discharged home or transferred to the referring hospital.  Full recovery to baseline function can take many months.

Complications can occur and whether minor or major, occur in 30 to 40% of people.  Complications from the chemotherapy are rare, and have not been seen in our cohort of patients.  In some instances, a stoma is required and may be permanent or temporary.  For women of childbearing age, it is important to let your specialist know if you are planning to have a family, as there is an opportunity to be referred to a fertility specialist.

Surgery is very daunting, especially for those living outside of Waikato.  There are options for accommodation for family, the details of which can be provided.  We also have patients who are more than happy to talk about their past experiences, and this can be particularly helpful for some people.  For any queries, please contact Jay Hayden at peritonectomy@waikatodhb.health.nz.

Mr Simione Lolohea

Mr Simione Lolohea

Colorectal, General and Laparoscopic Surgeon, Endoscopist

BHB, MBChB, FRACS

Areas of specialisation:

  • Colon and rectal conditions
  • Perianal conditions
  • Laparoscopic colectomy
  • Laparoscopic cholecystectomy
  • Laparoscopic inguinal/incisional hernias
  • Pelvic floor disorders
  • Colonoscopy and gastroscopy
  • Pseudomyxoma peritonei
Mr Ralph Van Dalen

Mr Ralph Van Dalen

Colorectal, General and Laparoscopic Surgeon, Endoscopist

MB ChB (Otago 1985) FRACS (1995)

Trained in Dunedin and completed surgical training in Christchurch. Spent 3 years in England to further colorectal training.  Worked in Waikato since 2001 as general and colorectal surgeon...  
Mr Linus Wu

Mr Linus Wu

Colorectal, General and Laparoscopic Surgeon, Endoscopist

BHB, MBChB, FRACS

Areas of specialisation:

Management of colorectal cancer
Inflammatory bowel disease
Functional bowel disease
Benign anorectal conditions
General surgical conditions such as hernia including complex abdominal wall reconstruction and gallstone disease...  
Mr Jasen Ly

Mr Jasen Ly

Colorectal, General and Laparoscopic Surgeon, Endoscopist

Honorary Senior Lecturer in Surgery University of Auckland
NZAGS Executive Committee Member
Current Hospital Supervisor General Surgery SET Program

Medical Specialties

  • Colorectal cancer
  • Cytoreductive surgery with HIPEC
  • Pelvic floor disorder
  • Anorectal disease
  • Inflammatory bowel disease
  • General surgery
  • Upper and lower GI Endoscopy
Mr Nick Smith

Mr Nick Smith

Colorectal, General and Laparoscopic Surgeon, Endoscopist

MBChB (Dist...  
Jay Haden

Jay Haden

Clinical Nurse Specialist - Colorectal Cancer

Jay's role is extremely varied within the colorectal team. Her main focus being the facilitation and care of each patients journey and ensuring their pathway of care is focused and meets each individuals needs.