Appendix Cancer — CRS and HIPEC - Hyperthermic Intraperitoneal Chemoperfusion: treatment in the Best Hospitals of Germany
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University Hospital of Ludwig Maximilian University of Munich
Department of General, Abdominal, Transplant, Hepatopancreatobiliary, Colorectal, Endocrine, Bariatric Surgery and Hernia Surgery
The Department of General, Abdominal, Transplant, Hepatopancreatobiliary, Colorectal, Endocrine, Bariatric Surgery and Hernia Surgery provides the full range of services in the areas of its specialization and holds a leading position at the national and international levels in terms of the number of surgical interventions performed and their success. Of particular interest are operations for treating diseases of the bowel, stomach, esophagus, pancreas, liver, gallbladder, and bile ducts, and endocrine glands. The department's doctors have excellent skills in the surgical treatment of cancer, surgery for liver, kidney, pancreas, and small intestine transplants, and operations for morbid obesity. The department's operating rooms are the pride of the medical facility, since they have all the necessary technical options for performing operations with the da Vinci surgical system, image-guided interventions, and endoscopic surgical procedures, which are characterized by minimal trauma rates.
Department of General, Abdominal and Vascular Surgery
According to the Focus magazine, the Department of General, Abdominal and Vascular Surgery ranks among the top German medical facilities specializing in the treatment of bowel and lung cancer! The department offers all the modern surgical options for the treatment of diseases of the abdominal cavity and blood vessels. The department's doctors have expert knowledge and vast experience in the treatment of colorectal cancer, stomach, esophageal, pancreatic cancers, liver metastases, inflammatory bowel diseases (diverticular disease, Crohn's disease, ulcerative colitis). Also, they specialize in the surgical treatment of vascular pathologies and thyroid diseases.
Department of General and Abdominal Surgery, Hepatopancreatobiliary Surgery, Colorectal Surgery, Endocrine Surgery, Hernia Surgery and Bariatric Surgery
The Department of General and Abdominal Surgery, Hepatopancreatobiliary Surgery, Colorectal Surgery, Endocrine Surgery, Hernia Surgery and Bariatric Surgery offers the full range of effective surgical treatments in accordance with modern medical standards. Operations of varying complexity are performed on the stomach, colon, pancreas, liver, gallbladder, bile ducts, rectum, thyroid gland, and parathyroid glands in the department's operating rooms every day. The department's primary focus is the surgical treatment of malignant gastrointestinal tumors. The medical facility is certified in this area by the German Cancer Society (DKG). The team of endocrine surgeons specializes in the treatment of diseases of the thyroid gland, parathyroid glands, and adrenal glands. Patients with morbid obesity are also successfully operated on here. In their work, the department’s specialists primarily use minimally invasive surgical techniques, which virtually eliminate trauma to healthy tissue during the intervention. The department's operating suite is equipped with an innovative da Vinci Surgical System, which allows the doctors to perform sparing and high-precision surgical interventions. The specialists of the medical facility strictly adhere to hygiene and safety standards and create the most comfortable conditions for each patient during their hospital stays.
Department of Abdominal and Colorectal Surgery, Hepatobiliary Surgery, Hernia Surgery, Bariatric Surgery, Endocrine Surgery, Thoracic and Vascular Surgery
The Department of Abdominal and Colorectal Surgery, Hepatobiliary Surgery, Hernia Surgery, Bariatric Surgery, Endocrine Surgery, Thoracic and Vascular Surgery offers the full range of services in these medical fields. It provides surgical treatment of diseases of the gastrointestinal tract, thyroid and parathyroid glands, thoracic organs, vascular system, rectum, anus and colon. In addition, the department performs bariatric interventions for the treatment of morbid obesity. A special focus is made on the treatment of gastrointestinal cancer. Minimally invasive surgical techniques are always preferred, if clinically indicated. The team of the department's surgeons has 8 progressive operating rooms equipped with everything necessary for successful treatment. The department also has the da Vinci Xi surgical system for high-precision minimally invasive robot-assisted interventions. The patient's health is in the safe hands of the best German surgeons who have gone through a rigorous selection and have vast clinical experience.
Department of General and Abdominal Surgery
According to the Focus magazine, the Department of General and Abdominal Surgery ranks among the top German departments specializing in bowel cancer treatment! The department offers the full range of classical and minimally invasive methods for the treatment of common surgical diseases, cancer pathologies, diseases of the endocrine organs, proctological problems. The specialization also covers transplant surgery (liver, kidney and pancreas transplantation). The department is certified by the German Cancer Society for its outstanding results in the treatment of bowel, pancreatic, stomach and liver cancers.
Department of Adult and Pediatric General, Abdominal, Transplant Surgery
According to Focus magazine, the Department of Adult and Pediatric General, Abdominal, Transplant Surgery ranks among the top German medical facilities specializing in bowel cancer treatment! The department performs surgical treatment of general surgical diseases, abdominal pathologies, and also specializes in organ transplantation. Of particular interest are surgical oncology of the abdominal organs, as well as pancreatic and liver surgery. The department annually performs more than 3,000 surgical interventions, which contributes to its credibility at the national level.
Department of Abdominal, Thoracic and Vascular Surgery
The Department of Abdominal, Thoracic and Vascular Surgery offers all modern surgical interventions in these fields. Specialization covers the treatment of diseases of the abdominal organs, endocrine glands, pathologies of the lungs and chest wall, pathological vascular lesions of all parts of the body. In addition, kidney transplantation and pancreas transplantation are part of the surgeons' tasks. Whenever possible, operations are performed using minimally invasive techniques that have several advantages over classical interventions.
Department of General, Abdominal and Vascular Surgery
According to the Focus magazine, the Department of General, Abdominal and Vascular Surgery ranks among the top German medical facilities specializing in the treatment of bowel cancer! The department offers the full range of surgical treatment of diseases of the abdominal organs and blood vessels, including the transplantation of abdominal organs. The sparing minimally invasive surgical techniques are widely used in the clinical practice, which allow to provide treatment in simple and complex clinical cases by making small incisions and using special tiny surgical instruments. The exceptional experience and profound knowledge of the department's doctors are also an integral part of the high treatment success rates.
Department of General, Abdominal, Vascular and Endocrine Surgery
The Department of General, Abdominal, Vascular and Endocrine Surgery offers the full range of medical services in these fields. The department specializes in the surgical treatment of gastrointestinal cancers (surgical treatment of pancreatic, liver, stomach, esophageal and colon malignancies), hernia repair, treatment of gastrointestinal inflammatory diseases, endocrine surgery and surgical correction of vascular diseases and defects. The treatment of patients is carried out in close cooperation with the experts from related fields, particularly, with oncologists, gastroenterologists, radiologists, angiologists, etc.
Department of General, Abdominal and Transplant Surgery
According to the Focus magazine, the Department of General, Abdominal and Transplant Surgery ranks among the top German departments specializing in bowel cancer treatment! The department offers the full range of services in these medical fields and guarantees the first-class medical care at the university level. The department specializes in the treatment of diseases of the abdominal cavity, esophagus and thyroid gland, transplantation of liver, kidney and pancreas. The medical facility has won the reputation of one of the three largest and most successful Transplant Centers in Germany. Also, within the clinical practice, doctors hold highly-specialized consultations on rare diseases and provide 24-hour emergency care.
Department of General, Abdominal and Thoracic Surgery
According to the Focus magazine, the Department of General, Abdominal and Thoracic Surgery ranks among the top German departments specializing in bowel cancer treatment! The department offers the full range of surgical treatment of diseases of the thorax and abdomen, endocrine glands, blood vessels and morbid obesity. If possible, the preference is always given to sparing minimally invasive surgical techniques. The department performs more than 3,000 outpatient and about 2,600 inpatient interventions every year. The department has one of the largest interdisciplinary Obesity Centers, as well as one of three supraregional Centers for Pancreatic, Stomach and Esophageal Surgery.
Department of General, Abdominal, Transplant, Vascular and Pediatric Surgery
The Department of General, Abdominal, Transplant, Vascular and Pediatric Surgery covers the whole range of services in these fields. The department specializes in the treatment of diseases of the upper and lower gastrointestinal tract, liver, gallbladder, pancreas, thyroid and parathyroid glands, adrenal glands, as well as overweight. In addition, the department is a recognized Center for Vascular and Pediatric Surgery.
Department of General, Abdominal, Adult and Pediatric Transplant Surgery
According to the Focus magazine, the Department of General, Abdominal, Adult and Pediatric Transplant Surgery ranks among the top German departments specializing in the treatment of bowel cancer! The department specializes in the treatment of tumors of the gastrointestinal tract, pancreas, liver, and retroperitoneal space (peritoneal carcinomatosis), liver, kidney, pancreas, bowel transplantations in children and adults, as well as the surgical treatment of obesity and general surgical interventions.
Department of Adult and Pediatric General, Abdominal, Hepatobiliary, Endocrine, Thoracic and Hernia Surgery
The Department of Adult and Pediatric General, Abdominal, Hepatobiliary, Endocrine, Thoracic and Hernia Surgery offers the full range of services in these fields. The team of the department's surgeons is rightfully proud of their high professionalism and successfully performs operations of varying degrees of complexity for diseases of the thyroid and parathyroid glands, stomach, esophagus, intestines, pancreas, liver, biliary tract, lungs. The medical facility also performs surgery for inguinal, umbilical and incisional hernias. The department has four high-tech operating rooms equipped with advanced surgical instruments, computer systems, devices for intraoperative ultrasound scanning, radiography, etc. Whenever possible, the department's surgeons perform low-traumatic laparoscopic procedures, after which patients need to spend only a few days in the hospital. The department has 100 beds for patient hospitalization.
Department of General, Abdominal and Transplant Surgery
According to the Focus magazine, the Department of General, Abdominal and Transplant Surgery is ranked among the top German medical facilities specializing in the bowel cancer treatment! The department offers the full range of services in these medical fields. The main clinical focuses include the surgical treatment of abdominal oncopathology, robotic surgery, minimally invasive surgery, endoscopy, organ transplantation and intensive care after surgical treatment. The department's doctors have special competence in the treatment of intestinal, pancreatic, stomach and liver cancers (certification of the German Cancer Society).
Department of General, Abdominal and Pediatric Surgery
The Department of General, Abdominal and Pediatric Surgery offers the full range of surgical treatment of diseases of the organs of abdominal cavity, thorax, emergency surgical care in polytrauma, as well as many surgical interventions in children. Of particular interest is cancer surgery on the liver, gallbladder, and pancreas. In addition, the department's specialists masterfully manage all the methods of bariatric surgery. Many operations are performed using minimally invasive techniques, which facilitate the quickest possible recovery of the patient.
Appendix cancer is a rare group of neoplasms, mainly represented by mucinous and neuroendocrine tumors. The main treatment method for this pathology is cytoreductive surgery (CRS). Doctors in hospitals in countries with advanced healthcare systems also supplement it with hyperthermic intraperitoneal chemotherapy (HIPEC), which increases patient survival rates and the chance of a complete cure for cancer.
Content
- Who may be a candidate for HIPEC therapy for appendix cancer?
- What is the process of appendix cancer treatment?
- Results of appendix cancer treatment with CRS and HIPEC
- How can I undergo treatment in Germany for appendix cancer?
Who may be a candidate for HIPEC therapy for appendix cancer?
The procedure is performed for cancer that has spread throughout the peritoneum. It is performed intraoperatively, that is, immediately after tumor removal.
Indications for HIPEC are the following:
- Spread of the tumor throughout the peritoneum
- Damage to the appendix during surgery for a localized mucinous tumor
Doctors assess the spread of peritoneal carcinomatosis to determine whether CRS and hyperthermic intraperitoneal chemotherapy can be used for a patient with appendix cancer. The Peritoneal Cancer Index (PCI) is used to determine its severity. CRS and HIPEC are advisable when the PCI is up to 16, and in some cases, up to 22.
This is quite a high indicator compared to other diseases. For example, hyperthermic intraperitoneal chemotherapy for stomach cancer is performed only when PCI is up to 7 points. However, appendix tumors are less aggressive, so even with a significant spread to the peritoneum, patients can expect good treatment results.
In most cases, HIPEC therapy is used for mucinous neoplasms. It is also effective in treating other appendix tumors, including adenocarcinomas and malignant neuroendocrine tumors.
What is the process of appendix cancer treatment?
Treatment begins with cytoreductive surgery. Unlike radical surgery, this operation is not aimed at complete tumor removal because this result is considered impossible. The goal of the procedure is to shrink the size of the tumor.
When conducting cytoreductive surgery, the doctor at the Cancer Clinic aims to perform a complete cytoreduction. It is considered complete if the specialist has succeeded in removing all visible tumor foci.
Even such a successful operation does not always cure cancer. Cancer cells remain in the abdominal cavity and are invisible to the doctor. In the future, they will become a source of tumor recurrence.
Modern hospitals perform the HIPEC procedure immediately after surgery to solve this problem. At the final stage of the surgical intervention, doctors place a drainage system in the abdominal cavity, consisting of several tubes. Some tubes are used to administer fluid into the abdominal cavity, while others are used to drain it.
A solution with a high concentration of cytostatics is administered through the drainage system. The concentration can be up to 20 times higher than in blood plasma, so this treatment method works much better than intravenous (systemic) cytostatic chemotherapy. Cancer cells are rapidly destroyed, and the human body is minimally affected because the drugs are poorly absorbed into the blood due to the presence of the hemoperitoneal barrier.
The specific drugs and dosages used depend on the type of tumor, its degree of differentiation, the quality of cytoreduction performed, the carcinomatosis index, and the patient's condition. In addition, different hospitals have different approaches to HIPEC.
As a rule, the duration of perfusion is 1-2 hours. After its completion, doctors suture the wound and finish the operation.
Results of appendix cancer treatment with CRS and HIPEC
Countries that offer advanced medicine achieve excellent results in the treatment of appendix cancer. Most patients can undergo complete cytoreduction. The follow-up use of hyperthermic intraperitoneal chemotherapy can destroy microscopic clusters of cancer cells, minimizing the risk of recurrence.
In countries with advanced healthcare systems, the use of CRS and HIPEC in patients with a PCI less than 22 provides the following survival rates:
- Five-year survival rates: 54%
- Ten-year survival rates: 72%
In medicine, there are no criteria for cancer curability, so this term is not officially used. However, if the tumor has not recurred within 10 years, the probability of its recurrence in a more distant period is very low. Therefore, from the statistics mentioned above, it can be concluded that approximately half of the patients with appendix cancer and peritoneal carcinomatosis achieve complete recovery after surgery and intraperitoneal therapy, while the rest achieve long-term survival rates. This statistic includes patients with a PCI score between 16 and 21. If the PCI is less than 16, the likelihood of curing cancer is much higher.
The worst results are achieved in patients with severe peritoneal carcinomatosis, with a PCI of 22 points or higher. HIPEC and CRS provide these patients with a five-year survival rate in about 10% of cases. Therefore, in most hospitals in countries with developed medicine, this category of patients is not considered a candidate for intraperitoneal chemotherapy.
How can I undergo treatment in Germany for appendix cancer?
If you want to undergo surgery with hyperthermic intraperitoneal chemotherapy, you can go to one of the countries with developed medicine, and Germany is the optimal choice.
You can find out the cost of procedures, compare prices for treatment in different hospitals, and make an appointment for your treatment in Germany through the Booking Health website. Our website presents the world's leading hospitals. If you use the Booking Health service, the cost of services for you will be lower than if you seek medical help from the hospital directly. The reduction in cost is due to the absence of additional fees for foreigners.
The Booking Health specialists will help you select a hospital with vast experience in using cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for appendix cancer. The Booking Health specialists will take care of arranging your treatment in Germany and provide assistance and support during the whole period of your stay abroad.
Authors:
The article was edited by medical experts, board-certified doctors Dr. Vadim Zhiliuk and Dr. Nadezhda Ivanisova. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!
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