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![Page 1: Managing the patients experience of radical surgery with HIPEC for stage 4 colorectal disease Jackie Rodger Lead Colorectal Nurse Specialist Carol Baird.](https://reader036.fdocuments.us/reader036/viewer/2022062516/56649d965503460f94a7fe60/html5/thumbnails/1.jpg)
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
![Page 2: Managing the patients experience of radical surgery with HIPEC for stage 4 colorectal disease Jackie Rodger Lead Colorectal Nurse Specialist Carol Baird.](https://reader036.fdocuments.us/reader036/viewer/2022062516/56649d965503460f94a7fe60/html5/thumbnails/2.jpg)
Selection Criteria
• MDT discussion
• Diagnostic laparoscopy
• Metastatic disease
• Individuals fitness for proposed treatment
![Page 3: Managing the patients experience of radical surgery with HIPEC for stage 4 colorectal disease Jackie Rodger Lead Colorectal Nurse Specialist Carol Baird.](https://reader036.fdocuments.us/reader036/viewer/2022062516/56649d965503460f94a7fe60/html5/thumbnails/3.jpg)
Patient Choice- Big Decision
•Informed Consent
![Page 4: Managing the patients experience of radical surgery with HIPEC for stage 4 colorectal disease Jackie Rodger Lead Colorectal Nurse Specialist Carol Baird.](https://reader036.fdocuments.us/reader036/viewer/2022062516/56649d965503460f94a7fe60/html5/thumbnails/4.jpg)
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
![Page 5: Managing the patients experience of radical surgery with HIPEC for stage 4 colorectal disease Jackie Rodger Lead Colorectal Nurse Specialist Carol Baird.](https://reader036.fdocuments.us/reader036/viewer/2022062516/56649d965503460f94a7fe60/html5/thumbnails/5.jpg)
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
![Page 6: Managing the patients experience of radical surgery with HIPEC for stage 4 colorectal disease Jackie Rodger Lead Colorectal Nurse Specialist Carol Baird.](https://reader036.fdocuments.us/reader036/viewer/2022062516/56649d965503460f94a7fe60/html5/thumbnails/6.jpg)
3. Best Supportive Care
• Disease Progression
• Quality of life
• Palliative care for symptom management
![Page 7: Managing the patients experience of radical surgery with HIPEC for stage 4 colorectal disease Jackie Rodger Lead Colorectal Nurse Specialist Carol Baird.](https://reader036.fdocuments.us/reader036/viewer/2022062516/56649d965503460f94a7fe60/html5/thumbnails/7.jpg)
Specialist Nurse
• Information giving
• Psychological counselling
• Rehabilitation/symptom management
• Survivorship
![Page 8: Managing the patients experience of radical surgery with HIPEC for stage 4 colorectal disease Jackie Rodger Lead Colorectal Nurse Specialist Carol Baird.](https://reader036.fdocuments.us/reader036/viewer/2022062516/56649d965503460f94a7fe60/html5/thumbnails/8.jpg)
![Page 9: Managing the patients experience of radical surgery with HIPEC for stage 4 colorectal disease Jackie Rodger Lead Colorectal Nurse Specialist Carol Baird.](https://reader036.fdocuments.us/reader036/viewer/2022062516/56649d965503460f94a7fe60/html5/thumbnails/9.jpg)
![Page 10: Managing the patients experience of radical surgery with HIPEC for stage 4 colorectal disease Jackie Rodger Lead Colorectal Nurse Specialist Carol Baird.](https://reader036.fdocuments.us/reader036/viewer/2022062516/56649d965503460f94a7fe60/html5/thumbnails/10.jpg)
![Page 11: Managing the patients experience of radical surgery with HIPEC for stage 4 colorectal disease Jackie Rodger Lead Colorectal Nurse Specialist Carol Baird.](https://reader036.fdocuments.us/reader036/viewer/2022062516/56649d965503460f94a7fe60/html5/thumbnails/11.jpg)
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
![Page 12: Managing the patients experience of radical surgery with HIPEC for stage 4 colorectal disease Jackie Rodger Lead Colorectal Nurse Specialist Carol Baird.](https://reader036.fdocuments.us/reader036/viewer/2022062516/56649d965503460f94a7fe60/html5/thumbnails/12.jpg)
Case study 1 continued
• Laparascopic right hemicolectomyWith 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
![Page 13: Managing the patients experience of radical surgery with HIPEC for stage 4 colorectal disease Jackie Rodger Lead Colorectal Nurse Specialist Carol Baird.](https://reader036.fdocuments.us/reader036/viewer/2022062516/56649d965503460f94a7fe60/html5/thumbnails/13.jpg)
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
![Page 14: Managing the patients experience of radical surgery with HIPEC for stage 4 colorectal disease Jackie Rodger Lead Colorectal Nurse Specialist Carol Baird.](https://reader036.fdocuments.us/reader036/viewer/2022062516/56649d965503460f94a7fe60/html5/thumbnails/14.jpg)
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
![Page 15: Managing the patients experience of radical surgery with HIPEC for stage 4 colorectal disease Jackie Rodger Lead Colorectal Nurse Specialist Carol Baird.](https://reader036.fdocuments.us/reader036/viewer/2022062516/56649d965503460f94a7fe60/html5/thumbnails/15.jpg)
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
![Page 16: Managing the patients experience of radical surgery with HIPEC for stage 4 colorectal disease Jackie Rodger Lead Colorectal Nurse Specialist Carol Baird.](https://reader036.fdocuments.us/reader036/viewer/2022062516/56649d965503460f94a7fe60/html5/thumbnails/16.jpg)
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