1 / 16

Managing the patients experience of radical surgery with HIPEC for stage 4 colorectal disease

Managing the patients experience of radical surgery with HIPEC for stage 4 colorectal disease Jackie Rodger Lead Colorectal Nurse Specialist Carol Baird Colorectal Nurse Specialist. Selection Criteria. MDT discussion Diagnostic laparoscopy Metastatic disease

conan-dickerson
Download Presentation

Managing the patients experience of radical surgery with HIPEC for stage 4 colorectal disease

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Managing the patients experience of radical surgery with HIPEC for stage 4 colorectal disease Jackie Rodger Lead Colorectal Nurse Specialist Carol Baird Colorectal Nurse Specialist

  2. Selection Criteria MDT discussion Diagnostic laparoscopy Metastatic disease Individuals fitness for proposed treatment

  3. Patient Choice- Big Decision Informed Consent

  4. 1. Surgery with HIPEC Major Surgery - stoma formation 20-40% of survival after 5 years 5-10% risk of mortality Lengthy stay in hospital Associated morbidity Quality of life issues following surgery

  5. 2. Systemic Chemotherapy • No invasive surgery • Short in patient stay/ medications at home • May experience side effect of chemotherapy agents • Not curative – aim prolonging survival • Quality of life

  6. 3. Best Supportive Care • Disease Progression • Quality of life • Palliative care for symptom management

  7. Specialist Nurse • Information giving • Psychological counselling • Rehabilitation/symptom management • Survivorship

  8. Case study 1 • 62 year old man • Presented 2007 2 month history of abdominal pain • CT scan caecal tumour with liver metastases • 6 courses of neo-adjuvant chemotherapy from May –August 2007 • Laparoscopic liver resection segment VIII October 2007

  9. Case study 1 continued • Laparascopic right hemicolectomy With RFA to sement V Nov 2007 • T4 N2 tumour (9/24 nodes) extensive extramural vascular invasion • 3 monthly scanning protocol due to adverse prosnostic features • April 2009 repair of incisional hernia diagnostic laparoscopy low volume peritoneal carcinomatosis no other metastatic disease

  10. Case study cont • Sub-total peritonectomy, resection of retroperitoneal recurrence with HIPEC August 2009 • Now 3 years out, well fit and active with no evidence of recurrent disease at present

  11. Case study 2 • 35 year old policeman • E/A Feb 20011 staphylococci bacteraemia. CT scan initially thought to be liver abcess • Further imaging liver mets with tumour rectum • Colonoscopy upper rectal cancer biopsy adenocarcinoma

  12. Case study 2 continued • Resection segment V111 and 1V of liver June 2011 • Anterior resection with defunctioning ileostomy July 2011 T4 N1 3/24 nodes, extramural vascular invasion • 6 week course of adjuvant chemotherapy August 2011-Nov 2011 • CT scan small small 3mm nodule lung • 3 monthly imaging regime

  13. Case study 2 continued • Reversal of ileostomy 1st February 2012 • CT scan 24/2/2012 new hepatic mets Nodule in lung measures 6mm • 21/5/12 Laparascopic Radio Frequency Ablation liver mets and biopsy of identified peritoneal nodules • 2/7/2012 Repeat anterior resection of rectum with seminal vesicles, small bowel resection, peritonectomy and HIPEC • Issues small lung module, retrograde ejaculation but recovered will back to normal activities

More Related