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PERITONEAL SURFACE ONCOLOGY
Cytoreductive Surgery (CRS)
The surgical foundation of peritoneal cancer treatment — a comprehensive operation to remove all visible tumour deposits from the peritoneum before HIPEC, aiming for complete cytoreduction.
ABOUT THE PROCEDURE
Removing Every Visible Tumour — The First Step to Cure
Cytoreductive surgery (CRS) is an extensive surgical procedure aimed at removing all macroscopic (visible) tumour deposits from the peritoneal cavity. It is the essential first step of the CRS + HIPEC combination — without adequate cytoreduction, HIPEC cannot achieve its full therapeutic effect.
The extent of the operation varies with disease burden. It may include peritonectomy (removal of the peritoneal lining from various abdominal surfaces), resection of affected bowel, spleen, gallbladder, uterus, or portions of the liver — whatever is required to achieve a complete resection (CC-0 or CC-1). The Peritoneal Cancer Index (PCI) score is used pre-operatively to quantify disease extent and plan the surgery.
CRS is a technically demanding operation requiring years of subspecialty training. Dr. Imaduddin completed his training at AIIMS and furthered his CRS + HIPEC expertise during his ESSO Fellowship at University Hospital Hannover under Prof. Dr. Beate Rau.
How It Is Performed
Pre-operative Assessment
PCI scoring from imaging (CT/MRI/PET), diagnostic laparoscopy if needed, and multidisciplinary tumour board review to plan resection.
Peritonectomy Procedures
Systematic removal of affected peritoneal surfaces — parietal and visceral peritoneum stripped from involved regions: diaphragm, pelvic peritoneum, greater omentum.
Organ Resections
Any organs with direct tumour involvement are resected: bowel, appendix, spleen, uterus, ovaries, or portions of liver as dictated by disease distribution.
CC Score Assessment & HIPEC
Completeness of Cytoreduction (CC) score is recorded. If CC-0 or CC-1 is achieved, HIPEC follows immediately in the same operation.
CANDIDACY
Who May Benefit?
Low-to-moderate PCI score
Best outcomes are achieved when peritoneal disease can be completely removed. PCI ≤20 for colorectal, ≤39 for appendix PMP are general thresholds.
Contained abdominal disease
Absence of significant extra-abdominal metastases — liver parenchymal or pulmonary metastases need individual assessment.
Good performance status
CRS is a major operation (6–12 hours). ECOG 0–1 and adequate cardiopulmonary reserve are required.
Chemosensitive or slow-growing tumour
Disease biology assessed by prior chemo response or tumour histology (e.g. low-grade appendix tumours have excellent outcomes).
M.Ch AIIMS · ESSO FELLOW
Trained in CRS at AIIMS and Hannover
Dr. Imaduddin completed his M.Ch Surgical Oncology at AIIMS — one of India’s most demanding surgical training programmes — and subsequently specialised in CRS + HIPEC during his ESSO Fellowship in Germany.
Get a CRS Assessment from a Specialist
Dr. Imaduddin reviews each peritoneal cancer case individually and provides clear guidance on whether cytoreductive surgery is appropriate, achievable, and in the patient’s best interest.