Heated Intraperitoneal Chemotherapy in Appendiceal Cancer Treatment

Abstract

Appendiceal cancer is rare and has been treated traditionally with repeated surgical debulking; however, cytoreductive surgery (CRS) with heated intraperitoneal chemotherapy (HIPEC) is becoming the preferred treatment modality because of improved survival. Nurses are responsible for knowing how to care for patients who are receiving or have received this treatment and need to be prepared to provide education on oncofertility. This case study illustrates the nursing implications of pregnancy and childbirth following CRS with HIPEC.

Cytoreductive Surgery With Hyperthermic Intraperitoneal Chemotherapy, Part I: Introduction and Indications

“… destroy free or residual micrometastatic disease (ie, small, scattered peritoneal tumors or cancerous cytology found in abdominal fluid) while the tumor burden is minimal; provide chemotherapeutic agent(s) access to tissue surfaces at risk for tumor recurrence before cancer cells can become entrapped by the body's wound‐healing processes or covered by surgical reconstruction of abdominal structures; provide timely, focused, and targeted regional chemotherapy directly to the tumor(s) with greater concentrations of cytotoxic agents (20‐ to 1,000‐fold concentrations) than is possible via systemic chemotherapy administration; and administer reasonable adjuvant treatment …”

“…The staging system provides the peritoneal cancer index (PCI) score, which is based on the disease location, volume of the tumor(s), and extent of the resection required (Figure ) . The PCI score is used to assess the extent of PC throughout the peritoneal cavity: the higher the score, the worse the prognosis is for the patient . The surgeon determines the PCI score by measuring the largest tumor nodules found in 13 different regions of the peritoneal cavity (ie, lesion size scores).…”

“…Noncancerous cells can withstand temperatures up to 47° C (116.6° F) for one hour . Heat, therefore, has a targeted cytotoxic effect that results in apoptosis with minimal harm to normal cells . Heat also increases the pharmacokinetics (eg, absorption, distribution) of chemotherapeutic agents, causing greater medication uptake and penetration into cancer cells after CRS by increasing cell membrane permeability and improving membrane transport .…”

Cytoreductive Surgery With Hyperthermic Intraperitoneal Chemotherapy, Part II: Implementation

“…Most patients who leave the postanesthesia care unit intubated are extubated within 12 hours . Determining the unit into which the patient is admitted will depend on his or her acuity level and monitoring needs . Patients requiring hemodynamic surveillance, vasopressor support, and vigilant fluid and electrolyte balancing are admitted to the intensive care unit .…”

“…To support patient acuity, nurses may need to adjust the nurse‐to‐patient ratio for patients admitted to a surgical unit from the postanesthesia care unit during the immediate postoperative period . The average length of a hospital admission is 7 to 12 days, although it can be as long as 20 days . The following factors determine the patient's postoperative care level:…”