Peritonectomy: Information & Peritonectomy Specialists

A peritonectomy is a surgical procedure performed to remove the peritoneum. This type of surgery is typically necessary when the peritoneum is affected by tumors. Doctors refer to this condition as peritoneal carcinomatosis.

The surgical procedure usually involves removing

• the affected visceral peritoneum (peritoneum viscerale) and
• the abdominal wall (parietal peritoneum).

If peritoneal carcinomatosis has been diagnosed, surgical intervention is usually unavoidable. The main cause of peritoneal cancer is considered to be metastatic—that is, spreading—malignant tumors of the pelvic or abdominal organs. Specifically, these are metastases from other types of cancer in the abdominal cavity. The primary tumors include, for example,

• ovarian cancer,
• stomach cancer, and/or
• colorectal cancer.

If metastases reach the peritoneum and the omentum, the primary tumor is already at a very advanced stage.

The procedure discussed here ideally prevents further symptoms, most notably what is known as ascites. This is characterized, among other things, by

• breathing difficulties, 
• digestive problems,
• pain,
• a feeling of pressure, and
• a significant increase in abdominal circumference

may be noticeable.

In addition, peritonectomy can extend life expectancy. However, this requires combining the procedure with another advanced treatment known as HIPEC. Hyperthermic intraperitoneal chemoperfusion is a form of chemotherapy in which the abdominal cavity is flushed with chemotherapy drugs.

Depending on the location of the cancer, an omentectomy may be appropriate either as an alternative to or in addition to a peritonectomy. An omentectomy involves the removal of the omentum as well as parts of affected organs in the abdomen.

Peritoneal cancer, or peritoneal malignancies, is generally known as a serious, if not incurable, form of cancer. However, modern studies have led to groundbreaking findings that have enabled the development of various effective forms of therapy. There are now medical centers that specialize in treating this disease.

A major challenge is the fact that peritoneal cancer is often detected very late. This often happens more or less by chance, for example, when a doctor performs a procedure on the original tumor. If peritoneal carcinomatosis is suspected, laparoscopy and computed tomography (CT) scans, among other tests, can provide clarity.

Among the most important treatment methods in the case of purely palliative therapy (i.e., not aimed at a cure) are 

• immunotherapy and
• chemotherapy.

Both prevent the cancer from growing further. In addition, the tumor is surgically reduced in size so that it causes fewer symptoms—such as the digestive problems already listed—and fewer others.

A team of doctors from various disciplines decides whether surgery is appropriate in each individual case. In addition to oncologists (specialists in malignant cancers), including experts in peritoneal carcinomatosis, and surgeons, this may also include, for example, your long-time primary care physician. This doctor is most familiar with your medical history and your current state of health.

If a peritonectomy is chosen, relevant tests such as

• an ECG,
• blood pressure measurement, and
• blood tests

be performed.

Unfortunately, it is often not until during the procedure that a clear determination can be made regarding the feasibility of a peritonectomy with concomitant chemotherapy.

Patients are under general anesthesia for the entire duration of the procedure. This also applies to the subsequent removal of the peritoneum, which can be either complete or partial. The peritonectomy is followed by HIPEC. To ensure the best possible effect, the hyperthermic chemotherapy solution is heated to 40 to 43 degrees before the abdominal cavity is irrigated.

Because the concentration in HIPEC is approximately 30 times higher than in other chemotherapy treatment methods, the prognosis is better. The duration of the irrigation varies from case to case and ranges from one to several hours.

Due to the invasiveness of the procedure, postoperative care is typically provided by medically trained staff. After surgery, patients remain in the intensive care unit for about one day and are then transferred to a regular hospital room.

Depending on the type of cancer and the stage of the tumor, medical and nursing follow-up care is also provided here. This involves, among others,

• oncologists,
• surgeons,
• psychologists,
• nurses, and
• social services

are involved.

Close monitoring is required due to the potential complications and risks. Since the body is extremely weakened by the treatment, infections and delayed wound healing are not uncommon.

It is difficult to make general statements about the potential success of treatment. Since this condition is typically characterized by an advanced stage, treatment usually only involves

• relief of unpleasant accompanying symptoms,
• the prevention of complications such as ascites, and
• an increase in life expectancy.

The latter can range from several months to, ideally, several years. On average, the survival rate for people with abdominal cancer is less than one year.

Regular tumor board meetings and ongoing research enable the continuous advancement of treatment options. Building on this, there remains hope that, with the continuous progress of medicine and technology, the chances of a cure for those affected will also increase.