February 03, 2020
On December 5, 2019, Dr. Francisco Macedo, a surgical oncologist with North Florida Surgical Oncology, performed Cytoreductive Surgery (CRS) with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) on a 64-year-old female patient who was diagnosed with peritoneal carcinomatosis secondary to Stage 4 Mucinous Adenocarcinoma of the Appendix. She was deemed terminally ill as traditional chemotherapy is not effective for her disease. The HIPEC procedure, such as the one performed by Dr. Macedo, has been the only intervention associated with increased survival and potentially cure in certain patients with peritoneal carcinomatosis. This was the first time that this innovative oncological procedure was performed at North Florida Regional Medical Center (NFRMC), and its success paves the way for NFRMC to be the only hospital providing HIPEC in North Central Florida.
"This is done in elite cancer centers across the country, and we recently performed the first HIPEC here at NFRMC, where we have a multidisciplinary team of physicians engaged in the complex care of patients with cancer," said Dr. Francisco Macedo with North Florida Surgical Oncology. "We have medical oncologists, radiation oncologists, radiologists, interventional radiologists, gastroenterologists and pathologists who are all dedicated to treating these patients."
There are several complex and advanced abdominal cancers that can now be treated with CRS/HIPEC procedure that were previously considered fatal. The most common are appendix cancer, advanced colorectal cancer, Peritoneal Mesothelioma, ovarian cancer, primary peritoneal cancer and gastric cancer. Because of the aggressiveness of these cancers and their inability to respond to traditional chemotherapy, they are considered a terminal disease. The HIPEC procedure now gives these patients another treatment option to consider that can improve and extend their life, or even cure them of their cancer.
Before the HIPEC procedure is performed, the surgical team does a thorough evaluation and resection (removal) of all visible tumors in the patient's abdomen. Then, the HIPEC is performed, during which high doses of chemotherapy drugs heated to approximately 110 degrees Fahrenheit are administered directly into the inside of the abdomen through a perfusion system for approximately 90 minutes. This process helps penetrate and destroy cancer cells that would remain in the abdomen after surgery. Once this is done, the chemotherapy is completely flushed out of the abdomen with a saline solution and the surgery is completed.
"Oftentimes, these procedures are only done in major academic centers far from Gainesville or North Florida, so these patients have had to travel sometimes out of state to undergo these procedures. Now that they can have it done here close to family, we have noted a tremendous change in our patients' satisfaction and outcomes," said Dr. Macedo.
Dr. Macedo joined the NFRMC medical staff in August 2019, and has been working on instituting the HIPEC program at the hospital even before he arrived. Dr. Macedo's goal is to expand the HIPEC program and make NFRMC a high-volume center for the procedure. He performed NFRMC's second HIPEC procedure in late January, and currently has several other patients going through the diagnostic process.
"It's really satisfying for me as a surgical oncologist to offer patients this type of procedure, which can potentially cure them of metastatic cancer," said Dr. Macedo. "These patients sometimes have been seen by multiple physicians and they have been told that they have a fatal diagnosis. So they are usually just given palliative care and comfort care only. When we are able to talk about these cases, they feel there's hope, and we are able to, through a series of different diagnostic tests, understand if they are candidates for this type of procedure."
If you or a family member are interested in being considered as a candidate for the HIPEC procedure, you can schedule a consultation with Dr. Macedo by calling North Florida Surgical Oncology at 352-333-5680, or by visiting North Florida Surgical Oncology