Cytoreductive surgery, peritonectomy and HIPEC

For some time I have obliquely referred to "the Sydney option". Now I am in a position to give further information.

First some background. As I have previously written in this blog, my condition is known as "peritoneal metastasis". What that means is that cancer cells associated with my 2008 bowel tumour have escaped into my peritoneal cavity, seeding multiple tumours associated with the peritoneum, the membrane that forms the lining of the abdominal cavity and which covers most of the intra-abdominal organs and bowel. It is a relatively rare condition, in other words, you have to be unlucky with your bowel cancer to have this type of metastasis, and it is regarded as incurable, leading to death over a timescale on the order of 1 year. Unfortunately this peritoneal disease doesn't generally respond to systemic chemotherapy. My good luck has been to have an excellent response, but this response buys time, it is not a cure. Time is now running out. My CEA has plateaued and I can't take too much more of this chemical assault.

In April this year, my surgeon son Chris pointed out to me that a group in Washington DC, led by Professor Paul Sugarbaker, had pioneered a new type of surgery that seeks to cure peritoneal metastasis. The procedure is known as cytoreduction and peritonectomy with hyperthermic intraperitoneal chemotherapy. It involves completely resecting the peritoneum, removing all visible tumours, and where necessary resecting parts of the bowel. The gall bladder and spleen are permanently removed. As part of the surgical procedure the peritoneal cavity is filled with hot (43 C) highly concentrated chemotherapy agent, and for an extended period (~ 1 hour) worked into the tissue in an attempt to kill all remaining cancer cells. The physics behind this is straightforward. Once all visible tumours have been removed, what remains is small and has high surface to volume ratio, thus making it vulnerable to attack.

This is highly aggressive surgery, taking typically between 8 and 12 hours, with several days in intensive care in recovery, and at least three weeks following in a surgical ward. There is a high risk of complications, the most unpleasant being fistulae (bowel leakage).

This surgery is available only at selected places around the world, and not in New Zealand. However, as Chris pointed out to me, one of the very best facilities is at St George Hospital in Sydney, and led by surgeon, Professor David Morris.

In July I visited St George, met with Professor Morris and his team and, had my case assessed, based on multiple radiology. They gave me good odds for medium term (~ 2 to 5 years) survival and accepted me for surgery subject to funding, which they, being a public hospital team, preferred that I sought from the New Zealand health system. This surgery is not cheap!

In early August, my Wellington referring surgeon made a case to a New Zealand Ministry of Health fund known as the "Special High Cost Treatment Pool". Last night, I received advice that my funding had been approved. St George Hospital are now able to schedule me for surgery. probably at some time during the next 8 weeks.

I feel extraordinarily grateful to my country for supporting me in this. Miang and I were prepared to pay the full cost, but how gratifying to be supported as an extension of our public health system. This is is what St George wanted, to be able to provide this unique service to Australia and New Zealand.

My life is now about to enter a new phase. The surgical experience will be formidable, far more demanding than my 2008 bowel surgery, and will require all my strength. The risks are great, but this is my best chance of surviving beyond 2010. I look forward to this opportunity with fortitude and hope.