Cytoreductive surgery combined with HIPEC can even cure some of the peritoneal malignancies: Dr Sanket Mehta

Shahid Akhter, editor, ETHealthworld spoke to Dr Sanket Mehta, consultant surgical oncologist at Saifee Hospital, Mumbai, to know more about the latest advancements in the care of Peritoneal Surface Malignancy.

Peritoneal Surface Oncology Conference: Highlights
The society of the peritoneal surface oncology was established 6 years back and we have been doing an annual update every year. This is the 5th version of the annual update. When we started 5 years back it was in Bengaluru and we had an audience of 30 people and we had 3 international faculties. It has grown over the years and we have been performing this event in a new city every time. This time it has finally come down to Mumbai, it's a much grander scale with much more comprehensive program to help beginners as well as established surgeons in the field to further expand their knowledge.


In this conference, we have 8 international faculties, who are all members of the Peritoneal Surface Oncology Group International making it a star-studded faculty list along with 13 national faculties who have all come down to collaborate and to share their knowledge with each other as well as with junior surgeons.

Peritoneal Surface Oncology: Trends
First of all peritoneal surface oncology is a very niche terminology and disease set. Any abdominal malignancy, be it in gastrointestinal tract or of gynecological origin, can spread to the inner membrane of the abdomen which is called the peritoneum and that constitutes to a Peritoneal Surface Malignancy. So, treatment of diseases that are spread to the peritoneum is encompassed in the terminology 'Peritoneal Surface Oncology'. It involves the surgeon, the medical oncologist and the ancillary services to deliver good results.

Peritoneal Surface Oncology: Challenges
The biggest challenge about the peritoneal diseases is that currently there is a lack of awareness even among the medical professionals about this as a specific disease subset. The traditional teaching, I mean even when I was taking my general surgical oncology training, traditional teaching was that at the moment the disease spreads to the peritoneum it is a stage 4 cancer and cannot be cured and the patient would go on palliative chemotherapy.

But now with this new treatment modality or cytoreductive surgery combined with heated intraperitoneal chemotherapy or HIPEC, we can prolong the survival and even cure some of the patients who have these peritoneal malignancies. When we started off doing this 11 years back at Saifee Hospital, we were the only hospital offering this as a dedicated program. Now, we have proctored, taught, spread awareness through the society, but we are still lacking in our penetrance so that every doctor, surgeon, gynecologist knows that peritoneal surface malignancy needs to be treated by cytoreductive surgery and HIPEC.

Saifee Hospital has now become a teaching center. We have a dedicated fellowship program which has been running for the last 6 years. We have also been probably doing the largest number of cytoreductive surgery and HIPEC. We conduct awareness programs, proctoring, mentoring to help new surgeons from different cities to come and learn the subject at our hospital and we are doing this systematically 2 to 3 times every week. The high volume ensures that our results are better year on year (YoY) and we have been doing publications, surgical audits and everything that is necessary to expand our expertise. Recently, in the last 2 years, we have also started offering PIPEC which is pressurized intraperitoneal aerosolised chemotherapy- a new form of treatment for diseases which do not have a surgical option. So, when the disease is too far spread over the peritoneum and surgery is not possible, we can stabilize this disease with very minimum side effects using the option of PIPEC.

Cyto Reduction Surgery today
Globally, cytoreductive surgery is now being done by several high volume centers and I think in India, at least in Mumbai city, we are one of the highest volume center. We are doing an average of more than 200 cyto-reductive surgeries every year which qualifies as a huge volume center and our results are regularly published and we are one of the trend-setters. Along with several other centers in the world, of course, in this field.