96446 Chemotherapy administration into the peritoneal cavity via indwelling port or catheter

Name of the Procedure:

Chemotherapy Administration into the Peritoneal Cavity via Indwelling Port or Catheter
Common name(s): Intraperitoneal (IP) Chemotherapy

Summary

Intraperitoneal chemotherapy is a cancer treatment where chemotherapy drugs are delivered directly into the peritoneal cavity using a surgically placed port or catheter. This method allows high concentrations of chemotherapy to be in close contact with abdominal tumors.

Purpose

This procedure addresses cancers within the peritoneal cavity, such as ovarian cancer, primary peritoneal cancer, and some cases of gastric or colorectal cancer. The goal is to target and destroy cancer cells more effectively by delivering chemotherapy directly to the area of the abdomen where cancer is present, potentially leading to better outcomes and prolonged survival.

Indications

• Advanced ovarian cancer
• Primary peritoneal carcinoma
• Metastatic gastric or colorectal cancer with peritoneal involvement
• Positive cytology in peritoneal washings
• Adequate kidney, liver, and bone marrow function, as determined by pre-procedure assessments

Preparation

• Fasting for at least 6-8 hours before the procedure
• Pre-procedure blood tests to assess organ function and overall health
• Possible imaging tests (CT or ultrasound) to guide catheter placement
• Discussion of current medications with the physician, including any necessary adjustments

Procedure Description

1. The patient is positioned comfortably, often under local anesthesia with sedation or general anesthesia.
2. The skin is sterilized and draped.
3. An incision is made to place the indwelling port or catheter into the peritoneal cavity.
4. The catheter is threaded through the entry site, and the port is anchored securely under the skin.
5. Chemotherapy drugs are administered through the port into the peritoneal cavity over a set period.
6. The infusion may be followed by a dwell time where the patient retains the fluid to allow the drugs to interact with cancer cells.
7. The port is flushed with saline to ensure patency and to minimize blockage.

Duration

The entire procedure, including chemotherapy administration, typically takes a few hours. The placement of the port or catheter may take 1-2 hours, and the chemotherapy infusion may take an additional one to several hours based on the treatment plan.

Setting

The procedure is usually performed in a hospital, outpatient clinic, or specialized cancer treatment center.

Personnel

• Oncologist
• Surgical oncologist or interventional radiologist
• Oncology nurse
• Anesthesiologist (if general anesthesia is used)

Risks and Complications

• Infection at the catheter site
• Bleeding or injury to internal organs
• Chemotherapy-related side effects such as nausea, vomiting, and abdominal pain
• Catheter blockage or displacement
• Peritonitis (inflammation of the peritoneum)
• Formation of adhesions or scar tissue

Benefits

• Localized high-dose chemotherapy with lower systemic toxicity
• Potential for improved survival rates and tumor response
• Reduced systemic side effects compared to intravenous chemotherapy
• Targeted therapy with higher effectiveness for abdominal tumors

Recovery

• Post-procedure monitoring for immediate complications
• Pain management with prescribed medications
• Instructions for care of the catheter or port site to prevent infection
• Gradual return to normal activities, typically within a few days to a week
• Follow-up appointments for further chemotherapy sessions and monitoring

Alternatives

• Intravenous (IV) chemotherapy
  • Less localized effect but eliminates the need for a catheter
• Oral chemotherapy
  • May be less invasive but can have widespread side effects
• Surgical debulking followed by chemotherapy
  • More invasive but can improve effectiveness in conjunction with IP chemotherapy
• Palliative care options
  • Focus on symptom relief rather than aggressive treatment

Patient Experience

Patients may experience discomfort during port placement but it is generally managed with anesthesia. During chemotherapy infusion, sensations of fullness or pressure may occur. Pain management is a priority, and medications may be prescribed to manage side effects like nausea and abdominal pain. Following the procedure, normal activities can typically be resumed gradually, with careful attention to the catheter or port site to prevent infection. Regular follow-ups ensure the port remains functional and that the treatment is effective.