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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

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

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  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

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