Managing the patients experience of radical

surgery with HIPEC for stage 4 colorectal disease

Jackie Rodger Lead Colorectal Nurse Specialist

Carol Baird Colorectal Nurse Specialist

Selection Criteria

• MDT discussion

• Diagnostic laparoscopy

• Metastatic disease

• Individuals fitness for proposed treatment

Patient Choice- Big Decision

•Informed Consent

1. Surgery with HIPEC

• Major Surgery - stoma formation• 20-40% of survival after 5 years• 5-10% risk of mortality• Lengthy stay in hospital• Associated morbidity• Quality of life issues following

surgery

2. Systemic Chemotherapy

• No invasive surgery• Short in patient stay/ medications at

home• May experience side effect of

chemotherapy agents• Not curative – aim prolonging

survival• Quality of life

3. Best Supportive Care

• Disease Progression

• Quality of life

• Palliative care for symptom management

Specialist Nurse

• Information giving

• Psychological counselling

• Rehabilitation/symptom management

• Survivorship

Case study 1

• 62 year old man• Presented 2007 2 month history of

abdominal pain• CT scan caecal tumour with liver

metastases• 6 courses of neo-adjuvant

chemotherapy from May –August 2007

• Laparoscopic liver resection segment VIII October 2007

Case study 1 continued

• Laparascopic right hemicolectomyWith RFA to sement V Nov 2007• T4 N2 tumour (9/24 nodes) extensive

extramural vascular invasion• 3 monthly scanning protocol due to

adverse prosnostic features• April 2009 repair of incisional hernia

diagnostic laparoscopy low volume peritoneal carcinomatosis no other metastatic disease

Case study cont

• Sub-total peritonectomy, resection of retroperitoneal recurrence with HIPEC August 2009

• Now 3 years out, well fit and active with no evidence of recurrent disease at present

Case study 2

• 35 year old policeman• E/A Feb 20011 staphylococci

bacteraemia. CT scan initially thought to be liver abcess

• Further imaging liver mets with tumour rectum

• Colonoscopy upper rectal cancer biopsy adenocarcinoma

Case study 2 continued

• Resection segment V111 and 1V of liver June 2011

• Anterior resection with defunctioning ileostomy July 2011 T4 N1 3/24 nodes, extramural vascular invasion

• 6 week course of adjuvant chemotherapy August 2011-Nov 2011

• CT scan small small 3mm nodule lung• 3 monthly imaging regime

Case study 2 continued

• Reversal of ileostomy 1st February 2012• CT scan 24/2/2012 new hepatic mets

Nodule in lung measures 6mm• 21/5/12 Laparascopic Radio Frequency

Ablation liver mets and biopsy of identified peritoneal nodules

• 2/7/2012 Repeat anterior resection of rectum with seminal vesicles, small bowel resection, peritonectomy and HIPEC

• Issues small lung module, retrograde ejaculation but recovered will back to normal activities