Cytoreductive Surgery (CRS) is a procedure to remove all visible signs of cancer in the abdominal cavity. In particular it removes any lesions on the peritoneum – the surface layer of the cavity wall and some organs. This procedure is often followed by HIPEC.
Hyperthermic (or Heated) Intraperitoneal Chemotherapy (HIPEC) is a procedure that is intended to destroy any cancer cells in the abdominal cavity that are too tiny to see. A strong heated chemotherapy is circulated in the abdominal cavity to wash all of the surfaces of the abdominal wall and organs. Killing the cancer cells that it comes into contact with.
Both procedures CRS and HIPEC are done under general anaesthetic.
Angela Sage – CRS/HIPEC My story
In October 2021 I had Emergency Hartmann’s surgery for T4A sigmoid tumour with no lymph involvement. After surgery recovery I chose to take the offer of mop up, oral chemotherapy ‘Capecitabine’. During yearly surveillance my CEA levels appeared raised, a second blood test (a couple of months later) showed a continued increase in my CEA levels. A follow up CT scan highlighted activity around scar tissue, a further PET scan was undertaken for clearer analysis.
In January 2023 my consultant advised that there was a sign of peritoneal metastasis by my left ovary. I was advised that it could be treated with CRS HIPEC surgery and my case had been passed to The Christie for advice. I recall being fairly positive as I hadn’t a clue what a peritoneum was, let alone that I had one. I hit google search a great deal whilst I awaited news from The Christie. I discovered that the peritoneum is a continuous membrane that covers the abdominal and pelvic cavities. If left untreated, the cancer can cause bowel obstruction, pain and a build-up of fluid within the abdomen. Without the option of CRS HIPEC I would have been facing a palliative treatment route. However, when I realised the seriousness of my situation a tense time followed waiting for the outcome of MDT (multidisciplinary team) meeting where my case was discussed.
In February I was very fortunate to be given hope when I met Mr Sutton at The Christie who offered me CRS HIPEC surgery. All systems were go.
had a further CT scan at The Christie and pre operative appointments including meeting a therapist in pre-habilitation. Before the operation I spent two weeks with a spirometer exercising my lungs. The day prior to my operation I took pre operative nutrition drinks and also had to undertake bowel preparation.
19 April 2023 – 7.30am I was admitted into the care of The Christie. Just after 8.00 I walked to the theatre and an epidural was administered, followed by anaesthetic. I had Cytoreductive Surgery removing ovaries, omentum, and peritoneum. I also had a parastomal hernia repair in surgery. HIPEC treatment followed.
I awoke in the Critical Care Unit (CCU) around twelve hours later. I was awake and although groggy I was aware of my surroundings. A specialist nurse was very close at hand in CCU. I was attached to monitors and tubes including ;a Nasal Gastric tube, parenteral nutrition through a central line in my neck, a fentanyl pain relief driver and a catheter. On my first day in CCU I managed to wash myself and sit in a chair for a short while.
On day two, later in the day, I was taken up to the ward. I felt a little lost and vulnerable on the ward for a couple of days, it was frustrating being dependent on others and I felt quite low. I expressed this to my consultant (Mr Sutton) on his morning ward rounds.He gently and supportively said ‘You need to dig down deep right now.’ That is just what I did and the mood lifted. I used the spirometer to continue to exercise my lungs and it was surprising in the early days to see how my lung capacity had decreased. I was encouraged to sit in a chair each day and be as mobile as possible.
Each day small progress was made; be it a tube coming out, progressing from flavoured clear liquids to food,or my physical and mental strength growing. As well as nurses caring for me I had regular visits at my bedside from; physio, complementary therapy, rehab and the pain team, who all did a smashing job of getting me fit to go home, the place I wanted to be.
By day seven I was able to walk for a shower and go for lunch in the day room. Between days seven and ten I felt as if I was heading in the right direction.
I was discharged on day ten. At home I administered blood thinners and wore my surgical stockings as instructed. I also needed a few doses of Movicol in the early days too as things were a tad sluggish with my output. I took care to pace myself and didn’t lift heavy objects, I continued with physio exercises. I ensured I was as mobile as I could be, building up my walking distance each day.
Fatigue was my biggest battle really. I managed to sort HRT with my GP as I had been thrown into surgical menopause and ‘hot dos’ during a heat wave was…mmm an experience! I returned to work five months later and definitely appreciated a phased return.
Mr Sutton shared the news in my post operative appointment that the only cancer found had been around the ovary and it had still been peritoneal cancer due to the route the cancer took. All other biopsies taken during surgery were clear. This was a good position to be in. I would have six monthly surveillance CT scans for two years and then yearly scans to follow. My six month scan has been clear and progress to looking ahead to the future is working its way back into my mind.
Contributor: Angela Sage