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Multimodality treatment of stomach cancer with cytoreductive surgery and HIPEC (638482) | Asklepios Hospital Barmbek Hamburg - BookingHealth
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After that, you will undergo the necessary additional examination, such as the assessment of liver and kidney function, ultrasound scan and tomography of the abdominal organs. Based on the results of the examination, the physician will choose the surgical technique and the type of anesthesia. After that, preparation according to the preoperative standard will start.<\/p>\n\n<p style=\"text-align:justify\"><strong>Cytoreductive surgery<\/strong>&nbsp;begins with general anesthesia. The intervention is performed as open surgery, i.e. through the incision in the anterior abdominal wall, so that the surgeon can carefully examine the peritoneum and the surface of the abdominal organs. The surgeon removes affected by the malignant process areas of the stomach and peritoneum, metastases in other internal organs. This stage of the operation can take several hours, since the overall effectiveness of the treatment depends on the completeness of the malignant tissues removal.<\/p>\n\n<p style=\"text-align:justify\">At the next stage of the operation, the surgeon inserts several catheters into the abdominal cavity. Through the catheters, a heated solution of a chemotherapy drug is pumped inside. The special system maintains the required temperature (42-43 degrees Celsius), pressure and circulation rate of the medicinal solution. The solution mechanically flushes out blood clots and remnants of malignant tissues, and a heated chemotherapy drug destroys micrometastases in internal organs and lymph nodes (micrometastases can&rsquo;t be detected by the naked eye).<\/p>\n\n<p style=\"text-align:justify\">After 1-1.5 hours, the chemotherapy drug is removed from the abdominal cavity and the abdominal cavity is washed with saline. After that, the surgeon removes the catheters and sutures the incision of the anterior abdominal wall.<\/p>\n\n<p style=\"text-align:justify\"><strong>After the completion of the operation<\/strong>, you will be transferred to the ward of the intensive care unit, under the round-the-clock supervision of doctors and nurses. In 1-3 days after the operation, your drains will be removed and you will be transferred to a regular ward for further recovery. The whole treatment takes 10-12 days on average.<\/p>\n\n<p style=\"text-align:justify\">Finally, the attending physician will evaluate the results of&nbsp;<strong>control examinations<\/strong>, schedule the date of discharge from the hospital and give you detailed recommendations for further follow-up and treatment.<\/p>\n<\/div>","program_full_story_crm":"<ul>\n\t<li>Initial presentation in the clinic<\/li>\n\t<li>clinical history taking<\/li>\n\t<li>review of medical records<\/li>\n\t<li>physical examination<\/li>\n\t<li>laboratory tests:\n\t<ul>\n\t\t<li>complete blood count<\/li>\n\t\t<li>general urine analysis<\/li>\n\t\t<li>biochemical analysis of blood<\/li>\n\t\t<li>TSH-basal, fT3, fT4<\/li>\n\t\t<li>tumor markers&nbsp;<\/li>\n\t\t<li>inflammation indicators (CRP, ESR)<\/li>\n\t\t<li>indicators of blood coagulation<\/li>\n\t<\/ul>\n\t<\/li>\n\t<li>abdominal ultrasound scan<\/li>\n\t<li>CT scan\/MRI or PET-CT of abdomen<\/li>\n\t<li>preoperative care<\/li>\n\t<li>cytoreductive surgery to remove visible tumors<br \/>\n\tinside the abdomen and HIPEC<\/li>\n\t<li>histological and immunohistochemical<br \/>\n\texamination of removed tissues<\/li>\n\t<li>symptomatic treatment<\/li>\n\t<li>cost of essential medicines<\/li>\n\t<li>nursing services<\/li>\n\t<li>stay in the hospital with a full board<\/li>\n\t<li>accommodation in a 2-bedroom ward<\/li>\n\t<li>elaboration of further recommendations<\/li>\n<\/ul>\n<div class=\"program_how_program_going mt-4\"><h4>How program is carried out<\/h4><p style=\"text-align:justify\"><strong>During the first visit<\/strong>, the physician will conduct a clinical examination and go through the results of the available diagnostic tests. After that, you will undergo the necessary additional examination, such as the assessment of liver and kidney function, ultrasound scan and tomography of the abdominal organs. Based on the results of the examination, the physician will choose the surgical technique and the type of anesthesia. After that, preparation according to the preoperative standard will start.<\/p>\n\n<p style=\"text-align:justify\"><strong>Cytoreductive surgery<\/strong>&nbsp;begins with general anesthesia. The intervention is performed as open surgery, i.e. through the incision in the anterior abdominal wall, so that the surgeon can carefully examine the peritoneum and the surface of the abdominal organs. The surgeon removes affected by the malignant process areas of the stomach and peritoneum, metastases in other internal organs. This stage of the operation can take several hours, since the overall effectiveness of the treatment depends on the completeness of the malignant tissues removal.<\/p>\n\n<p style=\"text-align:justify\">At the next stage of the operation, the surgeon inserts several catheters into the abdominal cavity. Through the catheters, a heated solution of a chemotherapy drug is pumped inside. The special system maintains the required temperature (42-43 degrees Celsius), pressure and circulation rate of the medicinal solution. The solution mechanically flushes out blood clots and remnants of malignant tissues, and a heated chemotherapy drug destroys micrometastases in internal organs and lymph nodes (micrometastases can&rsquo;t be detected by the naked eye).<\/p>\n\n<p style=\"text-align:justify\">After 1-1.5 hours, the chemotherapy drug is removed from the abdominal cavity and the abdominal cavity is washed with saline. 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Multimodality treatment of stomach cancer with cytoreductive surgery and HIPEC

Asklepios Hospital Barmbek Hamburg

Hamburg, Germany
Program id # 638482
Doctor photo
Prof. Dr. med. Karl Jürgen Oldhafer
Department of General and Abdominal Surgery, Hepatopancreatobiliary Surgery and Hernia Surgery
Specialized in: general and abdominal surgery, hepatopancreatobiliary surgery, hernia surgery

The program includes:

  • Initial presentation in the clinic
  • clinical history taking
  • review of medical records
  • physical examination
  • laboratory tests:
    • complete blood count
    • general urine analysis
    • biochemical analysis of blood
    • TSH-basal, fT3, fT4
    • tumor markers 
    • inflammation indicators (CRP, ESR)
    • indicators of blood coagulation
  • abdominal ultrasound scan
  • CT scan/MRI or PET-CT of abdomen
  • preoperative care
  • cytoreductive surgery to remove visible tumors
    inside the abdomen and HIPEC
  • histological and immunohistochemical
    examination of removed tissues
  • symptomatic treatment
  • cost of essential medicines
  • nursing services
  • stay in the hospital with a full board
  • accommodation in a 2-bedroom ward
  • elaboration of further recommendations

How program is carried out

During the first visit, the physician will conduct a clinical examination and go through the results of the available diagnostic tests. After that, you will undergo the necessary additional examination, such as the assessment of liver and kidney function, ultrasound scan and tomography of the abdominal organs. Based on the results of the examination, the physician will choose the surgical technique and the type of anesthesia. After that, preparation according to the preoperative standard will start.

Cytoreductive surgery begins with general anesthesia. The intervention is performed as open surgery, i.e. through the incision in the anterior abdominal wall, so that the surgeon can carefully examine the peritoneum and the surface of the abdominal organs. The surgeon removes affected by the malignant process areas of the stomach and peritoneum, metastases in other internal organs. This stage of the operation can take several hours, since the overall effectiveness of the treatment depends on the completeness of the malignant tissues removal.

At the next stage of the operation, the surgeon inserts several catheters into the abdominal cavity. Through the catheters, a heated solution of a chemotherapy drug is pumped inside. The special system maintains the required temperature (42-43 degrees Celsius), pressure and circulation rate of the medicinal solution. The solution mechanically flushes out blood clots and remnants of malignant tissues, and a heated chemotherapy drug destroys micrometastases in internal organs and lymph nodes (micrometastases can’t be detected by the naked eye).

After 1-1.5 hours, the chemotherapy drug is removed from the abdominal cavity and the abdominal cavity is washed with saline. After that, the surgeon removes the catheters and sutures the incision of the anterior abdominal wall.

After the completion of the operation, you will be transferred to the ward of the intensive care unit, under the round-the-clock supervision of doctors and nurses. In 1-3 days after the operation, your drains will be removed and you will be transferred to a regular ward for further recovery. The whole treatment takes 10-12 days on average.

Finally, the attending physician will evaluate the results of control examinations, schedule the date of discharge from the hospital and give you detailed recommendations for further follow-up and treatment.

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About the department

The Department of General and Abdominal Surgery, Hepatopancreatobiliary Surgery and Hernia Surgery at the Asklepios Hospital Barmbek Hamburg offers the full range of services in the areas of its specialization. The department's surgical team successfully performs interventions for diseases of the stomach, esophagus, small intestine, large intestine, rectum, pancreas, liver, gallbladder, and bile ducts. Patients with various types of hernias, including inguinal, umbilical, and incisional hernias, are also operated on here. It should be noted that the department also performs cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC), which is an advanced treatment method for peritoneal carcinomatosis. The specialists at the medical facility strive to provide patients with not only effective but also as sparing treatment as possible. That is why the use of minimally invasive surgical techniques is a priority. Such an approach to treatment practically eliminates surgical risks and reduces the duration of a hospital stay. The department has the status of an Expert Center for Liver and Pancreatic Surgery as well as a Competence Center for Upper Gastrointestinal Surgery, which is confirmed by the certification from the German Society for General and Visceral Surgery (DGAV). In addition, the medical facility regularly demonstrates high success rates in the surgical treatment of gastrointestinal cancers, which are confirmed by the certification from the German Cancer Society (DKG). The department is headed by Prof. Dr. med. Karl Jürgen Oldhafer.

In the field of general and abdominal surgery, special attention is paid to the treatment of patients with stomach and esophageal cancers. The key treatment method for these cancers is surgery. Each patient's clinical case is studied during a multidisciplinary tumor board with the participation of gastroenterologists, oncologists, radiation therapists, and radiologists. Such an approach allows doctors to develop the most effective treatment regimen based on specific diagnostic data, such as the type of tumor, its location, size, stage, and type, as well as the patient's general health condition and the presence or absence of comorbidities. Treatment tactics for esophageal cancer largely depend on the location of the malignancy. Tumors in the cervical section of the esophagus are extremely rare and are usually treated with chemoradiation therapy. When the tumor is located in the thoracic section of the esophagus, surgery is performed through a transabdominal or transthoracic approach, and in some cases, neoadjuvant chemoradiation therapy can be performed before surgery. As for stomach cancer, the department's specialists offer two main types of surgical treatment, namely subtotal (indicated for patients with small tumors) and total (indicated for patients with large tumors) gastrectomy. A significant proportion of stomach and esophageal surgical procedures are performed in the department using sparing, minimally invasive techniques. In addition, the department is one of the few in Germany where stomach and esophageal surgical interventions, including particularly complex ones, are actively practiced using the advanced da Vinci surgical system. Robot-assisted interventions are characterized by the highest precision, ensure minimal trauma rate and blood loss, and practically reduce complications to zero.

The department's surgical team is also deservedly proud of its successful experience in cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy (HIPEC) for the treatment of peritoneal carcinomatosis. This oncopathology is usually a complication of other abdominal cancers that have reached advanced stages. It is worth noting that not so long ago, patients with peritoneal carcinomatosis were considered hopeless, but the implementation of the HIPEC procedure into clinical practice allowed the doctors to significantly extend their life expectancy. The essence of the treatment is as follows: cytoreductive surgery is performed, during which surgeons remove all cancer foci visible to the naked eye in the abdominal cavity, after which the abdominal cavity is rinsed for 60-90 minutes with a solution of chemotherapeutic agents heated to 41°C. HIPEC is characterized by high efficiency since chemotherapeutic agents do not enter the body through the blood vessels, as it happens with classical systemic chemotherapy, but are injected directly into the cancer focus, which contributes to the enhancement of the therapeutic effect. Injecting the chemotherapy drugs into the abdominal cavity also gives surgeons the opportunity to repeatedly increase their dosage without causing any severe side effects.

The department's team of hepatopancreatobiliary surgeons specializes in the treatment of diseases of the liver, pancreas, gallbladder, and biliary ducts. Surgeons excel in performing operations for benign liver diseases, including cysts, hemangiomas, adenomas, and focal nodular hyperplasia. The doctors use minimally traumatic surgical techniques whenever possible. The department also has vast experience in the treatment of liver cancer and liver metastases. In most cases, it is possible to perform surgical resection of a malignant tumor or liver metastases using minimally invasive techniques. In advanced stages of cancer, surgery may be contraindicated. In these cases, patients may undergo transarterial chemoembolization (TACE). This procedure is performed by interventional radiologists and involves blocking the blood vessels supplying the tumor, which leads to its destruction.

The department's range of surgical options includes the following:

  • General and abdominal surgery
    • Surgery for benign diseases
      • Surgery for gastroesophageal reflux disease
      • Surgery for diverticular disease
      • Surgery for stomach ulcers
      • Surgery for inflammatory bowel disease: Crohn's disease and ulcerative colitis
    • Surgery for malignant diseases
      • Surgery for stomach cancer
      • Surgery for esophageal cancer
      • Surgery for bowel cancer
      • Surgery for colorectal cancer
      • Surgery for gastrointestinal stromal tumors
      • Cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal carcinomatosis
  • Hepatopancreatobiliary surgery
    • Surgery for benign diseases
      • Surgery for liver cysts
      • Surgery for cirrhosis
      • Surgery for liver hemangiomas
      • Surgery for liver adenomas
      • Surgery for focal nodular hyperplasia
      • Surgery for cholecystolithiasis
      • Surgery for choledocholithiasis
      • Surgery for acute and chronic pancreatitis
      • Surgery for benign pancreatic tumors
    • Surgery for malignant diseases
      • Surgery for hepatocellular carcinoma
      • Surgery for liver metastases
      • Surgeries for gallbladder cancer
      • Surgery for bile duct cancer
      • Surgery for pancreatic cancer
  • Hernia surgery
    • Surgery for inguinal hernias
    • Surgery for umbilical hernias
    • Surgery for incisional hernias
  • Other medical services

Curriculum vitae

Higher Education and Professional Career

  • 1978 - 1984 Medical studies, Georg August University of Goettingen, as well as Internship at the University of Illinois, USA.
  • 1984 State Medical Examination, Georg August University of Goettingen.
  • 1985 Thesis defense, Georg August University of Goettingen.
  • 1984 Admission to medical practice.
  • 1984 - 1985 Training in experimental pathology, Hannover Medical School.
  • 1985 - 1986 Work in the Transplant Immunology Laboratory, Hannover Medical School.
  • 1986 - 1992 Internship, Department of Surgery, Hannover Medical School.
  • 1992 Surgeon, Hannover Medical School.
  • 1993 Appointed as Emergency Medical Service Physician.
  • 1993 Venia Legendi in Surgery, Hannover Medical School. Subject: "Ischemic and reperfusion injuries after liver transplant surgery".
  • 1993 - 1998 Senior Physician, Department of Abdominal and Transplant Surgery, Hannover Medical School; Head of the Transplant Program, Hannover Medical School.
  • 1998 Advanced training in Abdominal Surgery.
  • 1998 Extraordinary Professorship.
  • 1998 - 2002 Senior Physician, Department of General, Abdominal and Transplant Surgery.
  • Head, Section of Cancer Surgery, University Hospital Essen.
  • Since March 2002 Head Physician, Department of General and Abdominal Surgery, General Hospital in Celle, Academic Hospital of the Hannover Medical School.
  • Since February 2007 Head Physician, Department of General Surgery, St. Joseph-Stift Hospital in Celle.
  • Since July 2007 Head Physician, General Hospital in Celle.
  • Head Physician, Department of General and Abdominal Surgery, Hepatopancreatobiliary Surgery and Hernia Surgery, Asklepios Hospital Barmbek Hamburg.

Awards and Prizes

  • 1995 Award of the Year for the Best Transplant Research: "Assisted orthotopic liver transplant. A new therapeutic method for the treatment of acute liver failure", European Hepato-Pancreato-Biliary Association, Athens.
  • 1997 Best Presentation Award. Subject: "Hyperthermic isolated liver perfusion (HILP) with tumor necrosis factor", experimental research, European Congress of the International Hepato-Pancreato-Biliary Association.
  • 1999 Award for work on the subject: "Preoperative virtual planning of liver surgery using 3D liver models", Congress on Liver Tumor Surgery, Munich, University Hospital of Ludwig Maximilian University of Munich.
  • Award for work on the subject: "Image processing system for preoperative planning of liver surgery", German Roentgen Society, Wiesbaden.
  • 2004 Award for work on the subject: "Double rupture of the liver and spleen after minor trauma during treatment with Marcumar", Conference of the Society of North-West German Surgeons.

Photo of the doctor: (c) Asklepios Klinik Barmbek


About hospital

The Asklepios Hospital Barmbek Hamburg is an academic hospital of the University of Hamburg. The hospital was opened in 2005, and today it is one of the best and most modern medical centers in Europe. The priority areas of specialization of the medical facility are emergency medical care and comprehensive treatment of cancer, urologic diseases, gastrointestinal diseases, and pulmonary diseases, as well as abdominal surgery and thoracic surgery. The hospital provides patients with top-class medical services that meet international standards. 

The hospital has 620 beds. More than 36,000 inpatients and about 74,000 outpatients are treated here every year. The patients' health is in the safe hands of a highly professional team of over 1,600 doctors and nursing staff.

The hospital offers high-quality diagnostic and therapeutic services and strictly follows current clinical protocols. The hospital boasts modern infrastructure and state-of-the-art medical equipment. The hospital is one of the few in Europe where patients are successfully operated on using the da Vinci surgical system. The hospital also houses well-equipped endoscopy rooms, cardiac catheterization laboratories, laser surgery rooms, and operating rooms for arthroscopic interventions. All these technical resources contribute to effective and, at the same time, minimally traumatic treatment.

It is worth noting that the hospital has vast experience in serving international patients. According to the Medical Travel Quality Alliance (MTQUA), the Asklepios Hospital Barmbek Hamburg ranks among the top three medical centers worldwide for medical tourism.

The medical center also holds the international DIN EN ISO 9001:2015 quality certificate, attesting to the excellent medical services provided. For its outstanding achievements in oncology and surgery, the hospital has been awarded certificates from the German Cancer Society (DKG) and the German Society for General and Visceral Surgery (DGAV).

Photo: (с) depositphotos

Accommodation in hospital

Patients rooms

The patients of the Asklepios Hospital Barmbek Hamburg live in comfortable single and double rooms. Each patient room has an ensuite bathroom with a shower and a toilet. The patient room furnishings include an automatically adjustable bed, a bedside table, a table and chairs for visitors, a TV, a radio, and a telephone. Wi-Fi access is also available in the patient rooms.

Patients can also be accommodated in enhanced-comfort rooms, which additionally include a rest area with upholstered furniture and a working area with a desk and a reading lamp. The bathroom in the enhanced-comfort rooms includes necessary toiletries, changeable towels, bathrobes, slippers, and a hairdryer. The enhanced-comfort rooms correspond to the standards of a high-class hotel.

Meals and Menus

The hospital offers tasty and balanced meals. Patients receive several menus to choose from and can see the menu in advance using a special mobile application. The hospital takes patients' food preferences into account and offers a wide range of dietary and vegetarian dishes. Breakfast, lunch, and dinner are served in the patient's room.

There is a cozy cafeteria on the first floor of the hospital where one can enjoy a cup of aromatic coffee or delicious tea with a dessert. The cafeteria offers a wide selection of snacks and salads.

There is a small store on the territory of the hospital where one can buy fresh fruits, yogurts, sweets, and magazines.

Further details

Standard rooms include:

Shower
Toilet
Wi-Fi
TV

Religion

There is a prayer room on the first floor of the hospital where patients can find solitude for prayer.

The hospital has an evangelical pastor who is happy to talk with patients and support them in the process of their treatment.

Representatives of other religions are available upon request.

Accompanying person

Your accompanying person may stay with you in your patient room or at the hotel of your choice during the inpatient program.

Hotel

You may stay at the hotel of your choice during the outpatient program. Our managers will support you for selecting the best option.