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Duodenal Cancer — CRS and HIPEC - Hyperthermic Intraperitoneal Chemoperfusion: treatment in the Best Hospitals in the World

University Hospital of Ludwig Maximilian University of Munich

10/10
location_onGermany, Munich

Department of General, Abdominal and Transplant Surgery

According to the Focus magazine, the Department of General, Abdominal and Transplant Surgery ranks among the best departments in Germany specializing in bowel cancer treatment! The department covers the full range of services in these medical fields and holds the leading position at the national and international level in terms of the number of surgical interventions performed and their success rate. Of particular interest are operations to treat cancer, organ transplants, as well as minimally invasive surgery.

Charite University Hospital Berlin

9/10
location_onGermany, Berlin

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.

University Hospital Ulm

8.7/10
location_onGermany, Ulm

Department of General and Abdominal Surgery

The Department of General and Abdominal Surgery offers the full range of surgical treatment of diseases of the esophagus and abdominal organs, thyroid and parathyroid glands, as well as the interventions in bariatric surgery. The surgeons of the department have a deep knowledge in all open and minimally invasive surgical techniques, perform extensive operations of high complexity with maximum safety for the patient.

University Hospital Carl Gustav Carus Dresden

9.1/10
location_onGermany, Dresden

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.

University Hospital Frankfurt am Main

10/10
location_onGermany, Frankfurt am Main

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.

University Hospital RWTH Aachen

9.2/10
location_onGermany, Aachen

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.

University Hospital Marburg UKGM

8.6/10
location_onGermany, Marburg

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.

University Hospital Halle (Saale)

9.6/10
location_onGermany, Halle

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.

University Hospital Jena

8.9/10
location_onGermany, Jena

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.

University Hospital Heidelberg

9.8/10
location_onGermany, Heidelberg

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. 

University Hospital Hamburg-Eppendorf

9.2/10
location_onGermany, Hamburg

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.

University Hospital Würzburg

9.2/10
location_onGermany, Würzburg

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.

University Hospital Tuebingen

9.2/10
location_onGermany, Tuebingen

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.

University Hospital Rechts der Isar Munich

9.8/10
location_onGermany, Munich

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.

University Hospital Muenster

9.8/10
location_onGermany, Muenster

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).

University Hospital Duesseldorf

9.5/10
location_onGermany, Duesseldorf

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.

Few decades ago, a diagnosis of duodenal cancer was a sentence that was not subject to appeal. Today in the field of surgical oncology it is possible to cure more than 80% of cases of duodenal cancer. Cytoreductive surgeries and hyperthermic intraperitoneal chemoperfusion are indicated to patients with advanced duodenal cancer, with peritoneal metastases.

Duodenal cancer overview

The duodenum is a part of the small intestine that has secretory and motor functions. This organ plays a significant role in the digestion process, bringing food coming from the stomach to an alkaline reaction that is optimal for the further digestion process. Depending on the food composition, it regulates the secretion of pancreatic and bile enzymes.

Duodenal cancer often develops in people over the age of 50 and is characterized by slow tumor growth.

Until now, the causes of cancer of the duodenum has not been established, but risk factors have been identified and currently include hereditary predisposition, diabetes mellitus, polyps in the large intestine, gallstones, chronic pancreatitis, and Crohn’s disease.

A connection of the cancer development with the Helicobacter pylori infection is also suggested. Bacterium-associated ulcers in the duodenum are more common (eight out of ten cases), while in the stomach they are present only in six patients out of ten cases. Peptic ulcer disease four times more often affects the duodenal mucosa than the stomach one. Mostly women suffer from duodenal ulcers, and men suffer from stomach ulcers. However, no connection was found between duodenal ulcer and the occurrence of duodenal cancer. Although, the connection of duodenal cancer with obesity has been noticed.

The possible causes of duodenal cancer are associated with an improper lifestyle. These are the consumption of alcohol and fatty foods, insufficient consumption of vegetables and fruits, and smoking.

Symptoms

Symptoms of early duodenal cancer do not differ from those of any other gastric disease and include:

  • Discomfort in the duodenum area
  • Pain in the epigastric region unrelated to food intake
  • Nausea
  • Periodic flatulence

Usually, patients with various types of indigestion consider these symptoms as an exacerbation of chronic gastritis, colitis, or peptic ulcer disease, but not a malignant tumor.

Clinical manifestations of duodenal cancer in most cases are caused by narrowing of the intestinal lumen:

  • With the localization of the tumor in the first section of the duodenum, the symptoms of stenosis may be present
  • When the duodenal tumor is located in the descending part, the first symptom may be obstructive jaundice due to blockage of the bile outflow; clinical signs of acute pancreatitis may be present
  • In case of cancer in the lower part of the duodenum, intestinal obstruction can develop (a progressively worsening condition with intoxication)
  • Growing of the tumor through the intestinal wall may cause presence of blood in the stool
  • Involvement of the pancreas is manifested by severe pain syndrome, similar to the symptoms of acute pancreatitis
  • At the metastatic stage of duodenal cancer, symptoms reflect the localization of foci in organs and tissues with progressive weight loss and increasing weakness

The vast majority of patients are under 50, although statistical information on duodenal cancer is somehow limited.

For duodenal cancer diagnosis, the esophagogastroduodenoscopy or EGD is used. During EGD, the organ is examined, and a biopsy is taken from pathological or suspicious areas. X-ray examination in different projections is also effective for diagnosis making.

Treatment

Unfortunately, surgery for the treatment of primary tumors and metastases in the abdominal cavity is not considered an efficient method in surgical oncology. Even the best surgeon can remove only those neoplasms that are visible or detectable. At the same time, metastases still remain, which means that the cancer is going to return.

Treatment with conventional chemotherapy is also ineffective in this case since it has little effect on primary and secondary tumors of the abdominal cavity. That is why hyperthermic intraperitoneal chemotherapy HIPEC is so important.

A team of doctors specializing in surgical oncology, which necessarily includes a surgeon and an oncologist specializing in the treatment of gastrointestinal cancer, decides if the patient is eligible for the HIPEC method. The presence of different specialists provides a comprehensive, individual approach not only during HIPEC but also at all stages of treatment and rehabilitation.

Cancer treatment with HIPEC is usually performed at the end of the surgery. Before the surgery, the patient must undergo all the necessary examinations: CT scan, colonoscopy, blood tests, etc.

The surgery begins with an examination of the abdominal and pelvic organs. The surgeon carefully removes all detected malignant formations. This surgery is called "cytoreductive surgery", and it requires competence and experience in surgical oncology. The operation to remove cancer cells from the abdominal cavity is quite difficult. The whole process of surgical intervention together with HIPEC can last about 16 hours, and the HIPEC procedure itself takes from 30 minutes to 90 minutes.

After making sure that there are no more visible tumors, the doctors begin the HIPEC chemotherapy session. If reconstructive surgery is required, such as stoma placement, etc., it can be performed either before or after "heated" chemotherapy.

HIPEC chemotherapy is performed in combination with surgical removal of the abdominal tumor. During cytoreductive surgery, the peritoneal cavity is carefully examined and all visible pathological foci (larger than 1-2 millimeters in size) are removed. After resection of the tumor, chemotherapy drugs are heated to a temperature of 42-43 degrees Celsius and are injected into the abdominal cavity through a catheter. The volume, flow rate, and temperature of the solution are constantly monitored using sensors and other medical devices. The devices constantly measure the temperature and pressure inside the abdominal cavity and automatically correct the parameters if they deviate from the norm.

The HIPEC treatment lasts on average about 1,5 hours. After the procedure, the solution is removed completely. Then the integrity of the surgical area is restored (if possible) and all incisions are sutured. The patient is transferred to an intensive care unit for a while.

As a rule, HIPEC is used to treat advanced cancer and makes it possible to destroy atypical cells and metastases. At the same time, in different cases in surgical oncology, the results of using the procedure differ. For example, HIPEC is successfully treating 50% of cases of ovarian cancer and 90% of cases of peritoneal pseudomyxoma.

Hyperthermic intraperitoneal chemotherapy (HIPEC) is contraindicated in the presence of massive adhesions in the abdominal cavity and severe cardiovascular diseases. Also, the procedure cannot be carried out in case of inflammatory processes in this area and after extensive surgical interventions. As a rule, chemotherapy HIPEC has no significant side effects. The severity of intoxication depends on the general health condition of the patient. The most common complications of the procedure are vomiting, nausea, weakness, and pain in the abdomen.

As the chemotherapy drugs practically do not enter the bloodstream, they do not cause intoxication. Therefore, in case of following rules of preparation for the procedure, as well as choosing the correct dose of the drug and the technique, the patient requires no special rehabilitation. It is enough to adhere to the rules of postoperative patient care and follow the recommendations of the attending physician.

Where can I undergo duodenal cancer treatment with HIPEC abroad?

Health tourism is becoming more and more popular these days, as duodenal cancer is successfully being treated with HIPEC abroad.

The following hospitals show the best success rates in duodenal cancer treatment with HIPEC:

  1. University Hospital of Ludwig Maximilian University of Munich, Germany
  2. Charite University Hospital Berlin, Germany
  3. University Hospital Ulm, Germany
  4. Tel Aviv Sourasky Medical Center, Israel
  5. University Hospital Carl Gustav Carus Dresden, Germany

You can find more information about the hospitals on the Booking Health website.

The cost of treatment

The prices in hospitals listed on the Booking Health website are relatively low. With Booking Health, you can undergo duodenal cancer treatment with HIPEC abroad at an affordable price.

The cost of treatment varies, as the price depends on the hospital, specifics of the disease, and the complexity of its treatment.

The cost of treatment with HIPEC in Germany is 38,446-67,692 EUR.

The cost of treatment with HIPEC in Israel is approximately 41,466 EUR.

You also need to consider the cost of possible additional procedures and follow-up care. Therefore, the final cost of treatment may differ from the initial price.

To make sure that the overall cost of treatment is suitable for you, contact us by leaving the request on the Booking Health website.

How can I undergo duodenal cancer treatment with HIPEC abroad?

It is not easy to self-organize any treatment abroad. It requires certain knowledge and expertise. Thus, it is safer, easier, and less stressful to shift some responsibility onto a medical tourism agency.

As the largest and most transparent medical tourism agency in the world, Booking Health has up-to-date information about duodenal cancer treatment with HIPEC in the best hospitals in the world. Therefore, we will help you select the right clinic taking into account your wishes for treatment.

We want to help you and take on all the troubles. You can be free of unnecessary stress, while Booking Health takes care of all organizational issues regarding the treatment. Our services are aimed at undergoing duodenal cancer treatment with HIPEC safely and successfully.

Medical tourism can be easy! All you need to do is to leave a request on the Booking Health website, and our manager will contact you shortly.




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