The unique combination surgery was successfully performed by HCG surgeons to treat a critical 40-year-old patient with appendix cancer (Mucinous Adeno Ca) spreading to the entire abdominal region

HCG Cancer Centre, Double Road, Bangalore recently set an exceptional benchmark in appendix cancer treatment by performing the unique Cytoreductive surgery with Hyperthermic Intra Peritoneal Chemotherapy (HIPEC) procedure on a 40-year-old man suffering from mucinous adenocarcinoma of the appendix. This type of cancer grows from the cells that make up the lining of the appendix.

While Cytoreductive surgery is the standard approach to reduce the number of cancer cells through the removal of the cancerous growth and involved organs in the abdomen, HIPEC is a procedure typically used to treat abdominal cancers that have spread beyond the originating organ to involve the peritoneal surface lining the abdomen. The combination of both procedures was brilliantly harnessed by Dr. Pampanagouda S K M – Senior Consultant Surgical Oncologist along with a multidisciplinary team accomplished the medical feat.

For over two months, Tejas S (name changed on request) a 40-year-old police department employee in the city suffered from abdominal pain. He either felt full soon after eating or had a bloated feeling. He would occasionally complain of nausea and vomiting. When he began to lose weight without any explanation, his seniors at work asked him to seek medical help. Upon a physical examination his doctor suspected that his abdominal pain was due to tuberculosis and put him on anti tubercular treatment.

When the symptoms exacerbated, his doctor conducted an appendectomy. However, when the symptoms persisted even after the surgery, his histopathology report revealed he was suffering from mucinous adeno carcinoma of the appendix. His family advised him not to lose time and to seek expert treatment at HCG Cancer Centre, Double Road.

At HCG Cancer Centre, Double Road, when Dr Pampanagouda studied his reports and found that despite the removal of the total appendix the tumor cells had spilled into Tejas’ peritoneal cavity, he and his team unanimously decided to perform the critical Cytoreductive surgery, followed by HIPEC (Hyperthermic Intraperitoneal Chemotherapy) procedure.

Explaining the expert treatment Dr. Pampanagouda S K M – Senior Consultant Surgical Oncologist, HCG Cancer Centre, Double Road, Bangalore said, “When the patient arrived at the hospital, he had abdominal mass with distension of the abdomen. Patient had biopsy of the abdominal mass to reconfirm the diagnosis Pseudomyxoma Peritonei (PMP), and had staging investigation done. The imaging report revealed the cancer had spread to other part of the abdomen to involve the peritoneal surface and omentum. That was when our multidisciplinary team decided that Cytoreductive surgery followed by HIPEC was the effective treatment. In view of the extensive disease, he received Neo adjuvant Chemotherapy. The patient condition was optimised and underwent surgery under general with epidural anesthesia. His blood and other vital parameters were stringently monitored to keep him stabilized throughout the nine hour-long procedure. We removed the patient’s entire abdominal wall lining (peritoneum) and complete large bowel (colon), conducted anastomosis (rejoining the ends) of the intestines, and removed the deposits over the mesentery (fold of membrane that attaches the intestine to the wall around the stomach area), followed by HIPEC procedure involving circulation of Chemotherapeutic drug solution throughout the abdomen for one hour with temperature maintained at 42 degrees centigrade. In HIPEC procedure, the cancerous tumor cells are treated with heated chemotherapy drug solution applied directly inside the abdomen to eliminate the remaining cancerous cells without much systemic toxicity of the drug.”

The patient responded extremely well to the surgery and recovered smoothly without any major complications. He was discharged from the hospital on 11^th day of major surgery.”

He further added, “HCG is a pioneer in oncological care in the country. We have been consistently performing major HIPEC surgeries which have been life-saving for patients like Tejas. All our patients undergo vital tests to ascertain their capacity to withstand the extensive surgical procedures. We are happy that the majority of the patients who undergo HIPEC procedure can lead a normal life with continued medications and lifestyle modifications under our care long after they leave our hospital.”

Commending his multidisciplinary team, Dr Pampanagouda attributed the success of the challenging case to dedicated team spirit and years of excellent experience in performing highly successful cancer surgeries.

Speaking about his experience, Mr Tejas said, “After suffering from constant pain for long time with weight loss and reduced appetite and going through appendectomy, followed by chemotherapy and major surgery for extensive disease, being able to live a normal life has been nothing short of a miracle. I am extremely grateful to the exceptionally proficient team of doctors at HCG Cancer Centre, Double Road for their patience, care and the precise treatment to relieve me of the cancer. The team of doctors took the time to explain every aspect of the surgeries and that I must entrust myself in their caring hands.”