A119
Complex issues for pseudomyxoma peritonei surgery in a district general hospital
Suzanne Alves, Victoria Stone
Basingstoke and North Hampshire Foundation Hospital, Basingstoke, UK
Background
Peritoneal malignancy is common and almost inevitably fatal in many intra-abdominal cancers. A small proportion of patients with peritoneal surface disease, particularly pseudomyxoma peritonei (incidence one per million per year, almost always from an appendix primary) may be amenable to complete cytoreductive peritonectomy with good palliation, long-term disease free survival and possibility of cure.
Referrals
Assessment of suitability for complete tumour removal and intraperitoneal chemotherapy is made by computed tomography and clinical examination.
Patient care
Patients attend an initial one hour appointment. An information leaflet is provided, outlining possible treatments, morbidity and mortality. A copy of the outpatient encounter is sent to the patient, referring clinician and General Practitioner to ensure all involved parties have identical information. Contact details of specialist nurse are given for clarification of any issues or questions.
All patients and relatives counselled to facilitate understanding of the operation and care, including epidural analgesia, Patient Controlled Analgesia (PCA), total parenteral nutrition, intraperitoneal chemotherapy and side effects, possible stoma formation, chest and abdominal drains, ITU requirements, deep vein thrombosis, and physiotherapy. An ITU visit is organised. A contact point is established for the day of surgery, which lasts, for an average of 10.5 hours.
Results
Two thirds of patients referred have surgery, of which two thirds have complete tumour removal and of these two thirds are cured.
Conclusion
This radical, time consuming surgery creates issues in holistic aspects of patient care. Nevertheless, overall satisfaction seems high and ongoing work progresses to refine and optimise the service.
