Innovative procedure saves man with appendix cancer

Last summer, 72-year-old Robert Bochat was carrying a heavy piece of furniture out of his house when he experienced chest pain and a pulled muscle. The Chicago resident thought he was having a heart attack, so his wife called 911.

Doctors found that the Bochat wasn’t having a heart attack, but had fluid in his abdomen. Further tests showed he had appendiceal cancer, or cancer of the appendix, a very rare condition that only affects about 1,000 Americans each year.

“Other than that one day, I was never in any pain or had any other problems,” says Bochat. “I was in shock that I actually had cancer in my appendix.”

Bochat eventually went to see Dr. Nikolaos Dallas, a surgical oncologist and general surgeon at the Creticos Cancer Center at Advocate Illinois Masonic Medical Center in Chicago. He is one of only a few physicians in the region who performs hyperthermic intraperitoneal chemotherapy (HIPEC) to treat localized appendiceal cancer, as well as, more common conditions like colon cancer and mesothelioma.

HIPEC involves delivering a very high dose of heated chemotherapy directly to the affected area of the abdomen during surgery.

“For appendiceal cancer, the only other treatment option is palliative chemotherapy, meaning chemotherapy used to treat cancer symptoms,” says Dr. Dallas. “For this type of cancer, HIPEC is the only curative option.”

Dr. Dallas says the 10 to 16 hour procedure involves five steps:

1. Exploration. In the operating room, the surgeon examines the patient to identify any organ that is affected by cancer. “It doesn’t benefit the patient if we don’t take all of it out,” Dr. Dallas says.
2. Resection. The surgeon removes all non-essential organs affected by the tumor. These could include the appendix, spleen, gallbladder, parts of the intestine and more.
3. Chemoprofusion. A very high dose of heated chemotherapy — higher than could be given to a patient through an IV — is administered directly into the patient’s abdomen. The patient’s abdomen is then closed up, and the surgical team shakes the patient for 60 to 90 minutes to help the chemotherapy target the entire affected area.
4. Removal of chemotherapy. The surgeon reopens the patient’s abdomen to remove the chemotherapy.
5. Completion. All remaining organs are replaced and reconnected.

After the procedure, the patient is admitted to the hospital for two to four weeks as their body recovers, says Dr. Dallas. While in the hospital, patients are monitored for any complications and complete physical therapy.

Bochat was able to go home after about two-and-a-half weeks.

“I feel great,” he says. “I don’t have any pain from the surgery, and it was great that they were able to remove everything in just one procedure. I just went in to see Dr. Dallas a couple weeks ago, and so far everything looks good. I haven’t had any recurrences.”

Because the procedure is so invasive, patients need to be relatively healthy going into it, Dr. Dallas says.

“Robert was a great candidate because he was in otherwise very good health when he received his diagnosis,” says Dr. Dallas. “If you are diagnosed with appendiceal cancer, colon cancer or mesothelioma and are unsure if you’re a candidate, I would definitely recommend talking to your doctor.”