Dr. Pandalai comes to the University of Kentucky with nearly a decade of experience in caring for patients with complex gastrointestinal malignancy. Previously he was a staff surgeon at the National Cancer Institute where he gained extensive exposure to HIPEC and other novel treatments for advanced stomach, pancreatic and liver cancer, while also serving as a primary investigator on clinical trials. Additionally he has served in the United States Army Reserve with Forward Surgical Teams in both Afghanistan and Iraq. He continues to serve our Veterans at the Lexington VA medical center and the Markey Cancer Center at the University of Kentucky.
LEXINGTON, Ky. (June 24, 2021) — Early in the evening of May 30, 2020, UK HealthCare trauma surgeon Dr. Zachary Warriner prepared an emergency operation to figure out the cause of a bowel obstruction. His patient, a 27-year old man, had come into the emergency department earlier that day with the vague symptoms of severe belly pain and nausea.
“He was in pretty significant discomfort,” said Warriner, assistant professor in the University of Kentucky College of Medicine Department of Surgery. “He was miserable and looking for some kind of relief.”
When a CT scan confirmed the blockage, Warriner’s team first tried a less invasive approach, attempting to use a colonoscope to pass the blockage and alleviate the pressure in his intestines. After attempting the procedure with various scopes to no avail, the surgery team had no choice but to open him up for an exploratory laparotomy to see exactly what was going on.
Around 1 in the morning, Warriner contacted the pathologist on call with bad news: he needed a tumor biopsy.
Prakash Pandalai, MD, assistant professor of surgery, surgical oncologist, University of Kentucky, Markey Cancer Center, discusses the use of cytoreductive surgery plus heated intraperitoneal chemotherapy (HIPEC) in the treatment of patients with colorectal peritoneal carcinomatosis.
Cytoreductive surgery and HIPEC are often thought of as a combination operation, but it’s actually 2 separate procedures, according to Pandalai. The goal of cytoreductive surgery is to remove all the gross visible tumors, resulting in a multi-visceral resection during which a small piece of the intestine, colon, or appendix can be removed if they are found to have tumor deposits.
After surgery is complete, it’s important to understand that the abdominal cavity can contain additional cancer cells following cytoreductive surgery, Pandalai explains. As such, catheters can be placed inside the abdominal cavity, allowing it to be profused for a period of time with chemotherapy that is infused in a heated solution.
Investigators set out to determine the value of each component of this regimen through the PRODIGE 7 study, during which patients were randomized to receive cytoreductive surgery with or without HIPEC. Through this approach, investigators were able to assess the efficacy of HIPEC, Pandalai concludes.
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