1. 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

2. Selection Criteria MDT discussion Diagnostic laparoscopy Metastatic disease Individuals fitness for proposed treatment

3. Patient Choice- Big Decision Informed Consent

4. 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

5. 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

6. 3. Best Supportive Care Disease Progression Quality of life Palliative care for symptom management

7. Specialist Nurse Information giving Psychological counselling Rehabilitation/symptom management Survivorship

11. 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

12. Case study 1 continued Laparascopic right hemicolectomy With 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

13. 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

14. 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

15. 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

16. Case study 2 continued Reversal of ileostomy 1 st 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