Peritonectomy at Waikato Hospital

To refer a person or for any enquiries:

• email: peritonectomy@waikatodhb.health.nz

You will need to complete an MDM form. You can request this when you contact us.

The referring clinician must contact a member of our colorectal team to verbally hand over the patient for discussion. The deadline for discussion is the Monday prior.

Discussions occur on Wednesdays at 7:40am and the outcome of the discussion will be emailed to the referring clinician. Ensure all relevant notes and scans are made available through email and the Waikato PACS system (radiology) for review prior to MDM.

Clinic appointments, if appropriate, will be scheduled within 2 to 4 weeks of referral, depending on the urgency required for surgery.

Time frames typically expected for surgery depend on:

• the indication
• volume of disease
• symptoms experienced by the patient.

Let us know if the patient is worsening, or you have any other concerns, so that we can increase their priority for treatment.

Other options for treatment include a referral to private, for patients who are insured. Referrals can be sent to Surgeons on Clarence:

• email: info@surgery.co.nz

If possible, patients are scheduled for a pre-anaesthetic assessment clinic on the day of their consultation in Waikato.

In some cases, an anaesthetic assessment is requested at the referring hospital which we may request.

Patients are booked in to come on the day prior to surgery, and will be visited by the treating team.

The treating team includes:

• surgeon
• anaesthetist
• colorectal CNS
• charge nurse
• stoma therapist.

The staging investigations required for work up depends on the indication, but would typically include:

• tumour markers (CEA, CA19-9, CA125)
• diagnostic laparoscopy with biopsy (or image guided core biopsy)
• assessment of PCI
• full staging CT scan
• colonoscopy.

A PET scan is essential for patients with colorectal cancer.

After surgery, patients are discussed at a pathology MDM and the slides are reviewed.

In some instances, adjuvant chemotherapy is recommended and a letter will go to the referrer to request a review from oncology at the referring institution. 

Surveillance guidelines are otherwise 4 monthly CEA, CA19-9 and CA125, except for colorectal cancer where CEA alone is tested.

CT scans are suggested at 1, 2, 3 and 5 years.

Recurrences may be suitable for repeat surgery with HIPEC, and we would appreciate a referral for discussion if a patient we have treated has had recurrent disease diagnosed.

Waikato Hospital has been providing cytoreductive surgery with heated intraperitoneal chemotherapy since 2008. The hospital has performed over 370 procedures, and the technique has been refined to a dedicated team of:

• surgeons
• anaesthetists
• oncologists
• theatre nursing staff
• perfusion equipment and personnel
• perioperative nursing care
• dieticians
• pathologists.

The majority of patients have been treated for pseudomyxoma peritonei which arises from the appendix, but an increasing number are offered surgery for colorectal cancer where there is limited peritoneal disease and no disease elsewhere in the body.

Waikato is one of 6 hospitals in Australia and Aotearoa New Zealand performing cytoreductive surgery with HIPEC, and are part of the ANZ Peritoneal Malignancy Collaboration, supporting research and the progression of this field of expertise in Australasia.

Waikato maintains a prospective database of patients for audit and research, to ensure that the highest level of care can be provided to our patients.

Waikato is also part of the ANZ Peritoneal Malignancy Collaboration, contributing to research and the development of consensus guidelines for the management of peritoneal disease.