This is how we peritoneal malignancy surgeons like to spend 13 hrs of a day....

Getting started: assess the extent of the peritoneal disease and make a plan for the resections that will be needed

In this case of #mesothelioma: extensive disease on all parietal and visceral peritoneum : showing here mesentery of colon)

All of Small bowel:

Pelvis: confluence of disease with inability to visualize rectum, uterus and ovaries

Summary: PCI 37 BUT no infiltrative growth and almost no involvement of the serosa of the SB —> complete cyto reduction achievable. Time to get to work-let’s do this

Starting to make progress: R diafragm done

Keep going: left diagram, omentectomy, splenectomy and lesser omentectomy done

We’re all warmed up now-time to get the pelvis done: en block peritonectomy w rectosigmoid rx and hist-BSO

Teamwork is everything!@IsabelRamosMD @dr_oriol We are not tired yet...there ‘s still all that visceral peritoneum waiting ...

Tedious work... but can be done. Compare and contrast cleaned up section with non- done section ( final 40cm of ileum that will be resected with R colectomy)

.... finally.... all the resections ( and recons) are done ... time for HIPEC!

Hour 13: back in for a check, confirm excellent hemostasis, look at anastomoses ( 2 in this case-ileocolic and colorectal, no ostomies), place drains

Great work by our anesthesia team- pt goes stable to the ICU. And we go home to sleep Let’s do it all over again tomorrow

Peritoneal mesothelioma is rare and difficult to treat but CRS and #HIPEC is a powerful tool to fight it @RENAPE_Network @FaheezM @kturaga @hralexander_MD @Mesouk @curemeso @indepso @oliviawriting #PaulSugarbaker