After the surgery you will have a wound, drains and an intravenous drip. Each of these sites can carry the risk of infection. Should you notice any new pain, redness, ooze or swelling e.g. at a drip site, please let a member of staff know. We will closely observe you for any signs of infection by monitoring your blood tests, temperature and  how you feel in general. A CT scan may be organised following a change in symptoms or if you are not progressing as predicted. The purpose of the scan is to look for any source of infection such as pocket of fluid in the abdominal space or in the chest. Treatment may be  a course of antibiotics, the removal of some surgical clips to allow drainage of fluid from  the wound or it may require a fine bore drainage tube to be inserted under local  anaesthetic in radiology. This tube would remain in position for a few days until the collection of fluid has been drained. Drainage procedure may be repeated as necessary during your hospital stay should further symptomatic collections of fluid occur. This is a very common procedure following peritonectomy surgery which most patients at some stage require. Infrequently, a return to theatre may be required for an open drainage of an infected abdominal collection and/or washout procedure.

We recommend you have access to a thermometer post discharge to monitor your temperature short term.

It is common that some bowel is cut out and the remainder needs to be joined back together (this is known as ‘anastomosis’). The chemotherapy may slow down the healing of the bowel join. If healing is slow and a leak from the bowel occurs, this is a major problem, and it may cause pain and infection. In about 5% of people the bowel contents can erode through tissue and end up coming out of the skin, bladder, vagina or surgical drain (this is known as a ‘fistula’).

If this occurs it can be managed by resting the bowel, keeping you ‘nil by mouth’ and feeding artificially via a drip until it heals. Sometimes, though rarely, it will require an operation to fix. Patients can feel physically well with a fistula, but this complication is frequently accompanied by feelings of frustration or anxiety as it may extend the hospital stay for several weeks. Please continue to communicate with us throughout your stay, let us know how you are feeling so we may be able to help you i.e. if you anxious or don’t understand what is happening

After peritonectomy your bowel will stop working (this is known as a ‘paralytic ileus’) and you will not be able to eat until the bowel starts to work again. This usually takes approximately 10 days, but in some cases,  this takes considerably longer and delays your recovery. In this instance artificial intravenous feeding may be commenced.

After any operation you will be given sufficient pain relievers to keep you comfortable. This requires careful attention on the part of the surgical doctors and pain team, and it may take some time for them to get the optimum treatment combination. The postoperative (cold) intraperitoneal chemotherapy can occasionally cause some additional pain, but this can usually be dealt with by giving extra pain killers. It is important that you let us know when you have pain so that we can deal with the problem as early as possible. We do not want pain to hinder your mobility. You need to be able to mobilise freely to facilitate your recovery.

On occasion, as a result of significant bowel resections, patients may need supplemental intravenous (IV) fluids at home to maintain hydration. In this instance the patient may be educated to follow a home IV fluid protocol.

The most serious potential side effect of chemotherapy is the lowering of your blood count. This makes you susceptible to bleeding or infections, which can be particularly problematic because the operation also makes you susceptible to these issues. Given the doses we use, most patients do not have problems with their blood counts. Other side effects (although rare when chemotherapy is given this way) include hair loss (uncommon and temporary), a sore throat and mouth, diarrhoea, nausea and vomiting.

Depending on which chemotherapy agent we plan to give, we may advise you to proceed with a blood test, at your own expense. This is to determine if you are in the rare population group (0.1%) that completely lacks the DPD enzyme which breaks down a commonly used drug called fluorouracil. This deficiency can potentially lead to a life threating drug toxicity if fluorouracil cannot be metabolised.  It is estimated that between 3-8% of the population may have up to 50% DPD inefficiency. This rare risk will be discussed during your meeting with the oncology consultant and further information be given if relevant to your case.

It is not uncommon for wounds to breakdown post-surgery due to nutritional deficiency, infection or delayed healing due to the chemotherapy. This is most often seen in the second week when it coincides with, but is not related to, the removal of the surgical staple/clip. It may range from slight weeping or superficial gaping on the surface of the wound to complete breakdown requiring specialised dressings. 

If a patient is well but has a wound requiring care, they may be discharged from hospital and referred to their local community nurses for management. If intravenous chemotherapy is planned after discharge home, all wounds must be healed before commencement. In some cases, this may take several weeks.

Patients are at high risk of developing blood clots following major surgery. The risk is greater in patients who have a cancer. To reduce this risk, patients are given injections to “thin the blood” e.g. heparin or Clexane^®. They are asked to wear support stockings for their entire hospital stay and be encouraged to mobilise as early and frequently as possible postoperatively.

If patients develop limb swelling or chest pain or shortness of breath, they will be investigated for deep vein thrombosis (DVT) or pulmonary embolus (PE) / lung clot. Treatment involves giving intravenous heparin and later oral tablets e.g. warfarin or long-term blood thinning injections (Clexane^®). On a few rare occasions, these blood-thinning drugs have had an adverse effect causing an unexpected bleed within the abdominal cavity requiring intervention. You will be closely monitored for any signs of bleeding whilst receiving these drugs.

Routinely, patients will be required to self-administer Clexane^® for 6 weeks after discharge. You will be educated on injection technique towards the end of your hospital stay. If you develop the above symptoms before or after discharge from hospital, please advise us or your local doctor immediately.

On rare occasions, pressure on a nerve in your arm or leg during the operation can cause nerve damage. Any damage to the nerve would usually be temporary but can take a long time to recover and affect your walking or use of a limb and may delay your recovery. Should this occur the physiotherapist will assist you with your management in hospital and a referral be made for ongoing physiotherapy in an outpatient setting nearer to your home.

Damage to pelvic nerves or structures during the operation may lead   to post-operative problems with sexual function. Please advise your GP if there are ongoing issues as help may be available. Men who undergo pelvic surgery as part of the peritonectomy may experience erectile dysfunction or ejaculation issues. Women may have their ovaries removed during the surgery resulting in early menopause or discomfort during intercourse. Hormone treatment may be recommended and commenced early in hospital if symptomatic. More information is available at www.ovariancancer.net.au.

Tiredness or general weakness is to be expected after an intensive treatment program. It can take several months – but it may take longer – to get your strength back up to normal. Occasionally patients may be referred for a rehabilitation exercise program if they are deconditioned after having spent several weeks in hospital.

The most serious risk is that a critical part of your body fails as a result of the treatment or its complications. Examples include kidney failure or lung failure, and these can lead to other problems including brain damage. Support can be given in intensive care to deal with these, such as dialysis for kidney failure or more prolonged time on the ventilator machine if the lungs are not working. However, if these problems become prolonged or insoluble, recovery may no longer be possible. This is what may have happened to those patients who have died as a complication of the procedure. Organ failure may be a side effect of the overall package of surgery and chemotherapy and sometimes specifically from the chemotherapy.

The risk of death from peritonectomy at St George Hospital is less than 2% based on our unit having performed over 1500 surgeries (as at June 2019).