The Peritoneum and Retroperitoneal Surgery UOC complex operating unit aims to treat primary and secondary tumours of the peritoneum and retroperitoneal sarcomas.
The activity is carried out in collaboration with other specialists (Medical Oncology, Oncological Gynecology, Radiotherapy, Radiology and Pathological Anatomy) by participating in weekly multidisciplinary meetings (Tumor Board SUPER - Surgical Unit of PEritoneum and Retroperitoneum) aimed at defining the best treatments for the individual patient, defined on a collegial basis.
The pathologies that are most frequently treated are:
primary tumours of the peritoneum (Pseudomixomas and Mesotheliomas),
peritoneal carcinosis of prevalent gastrointestinal origin,
tumours of the stomach,
colorectal,
pancreas,
retroperitoneal sarcomas,
GIST (Stromal tumours gastrointestinal),
abdominal lymph node metastases of disease.
Among the cutting-edge technologies used, we would like to highlight the following:
Peritonectomy is the surgical technique that allows removing all the visible macroscopic disease affecting the peritoneum and the affected organs (complete cytoreduction - CRS).
High-temperature intraoperative chemohyperthermia (Hyperthermic Intraperitoneal Chemotherapy - HIPEC) is administered to treat even non-visible residual peritoneal microscopic disease. The locoregional route of administration allows for higher concentrations of the anticancer drug to be reached in direct contact with the tumour and a consequent reduction in systemic exposure. Hyperthermia also has an intrinsic antitumor activity and increases the effectiveness of various chemotherapeutic principles.
The recently introduced PIPAC (Pressurized Intraperitoneal Aerosol Chemotherapy) method, was developed for the treatment of peritoneal carcinosis in patients who cannot be treated with cytoreductive surgery. This technique allows the drug to be administered via aerosol, through laparoscopic access, the execution of biopsies for histological study and the aspiration of ascitic fluid, if present. The goal of PIPAC is to control the further spread of carcinosis, prevent the ascites from returning, and, in cases with the best response, prepare the patient for curative cytoreductive surgery. The advantages are the repeatability of the method, the low invasiveness, the reduced incidence of side effects typical of systemic chemotherapy and the possibility of monitoring the response to local chemotherapy.
Innovative techniques
Innovative radiological techniques such as IGRT (Image Guided Radiation Therapy) and IMRT (Intensity Modulated Radiation Therapy) that allow you to visualize the pathological area to be treated, minimizing damage to adjacent healthy tissues. In particular, the MRIdian® - ViewRay system (available at the Gemelli Advanced RadioTherapy _ART centre) allows for guided IMRT treatments for the specific treatment of retroperitoneal sarcomas.
The current volume of oncological surgery performed at the Peritoneum and Retroperitoneum Surgery Unit of the Gemelli Polyclinic is more than 450 cases/year. The cases are divided as follows:
more than 200 cases/year of primary peritoneal tumours (mesothelioma, pseudomyxoma) or peritoneal carcinosis of gastrointestinal tumour origin (peritonectomy / multivisceral resections plus HIPEC or PIPAC treatments)
more than 200 cases/year of colorectal, gastric or biliopancreatic cancers are treated mainly with minimally invasive surgery (laparoscopic or robotic depending on the indications)
15-20 cases/year of retroperitoneal tumours, mainly sarcomas.
