cialty center. With the arrival of the program’s newest surgical oncologist miral Grandhi, mD, an assistant professor of surgery at Rutgers Robert Wood Johnson medical School, kennedy is looking to build on HiPec offerings at Rutgers cancer institute and develop a HiPec center of excellence for central New Jersey. to help patients with dietary intravenous needs since it takes an average seven to 14 days for normal digestive function to resume. Back in the Saddle Step by Step S chepisi was ready for the second HiPec — and even knew the risk of the doctor going in and realizing he may not be able to proceed. A seriousness came over the surgical team as they prepared her in the operating room. “i just looked at them and told them ‘this isn’t my first rodeo.’ i think i may have scared them, but it’s just my brand of humor,” she muses. Her “humor helps” mantra has been evident through many aspects of her journey. For instance, Schepisi had her hair styled by daughter Nicole — a hairdresser — during one of her visits when she needed a blood transfusion. This is also the woman who misinterpreted the immediate need for a stool sample and ended up bringing one in her designer handbag to be evaluated. After jokingly calling out kennedy on that misunderstanding, patient and doctor shared a hearty laugh. Following the procedure, it took Schepisi about a month for her to feel “normal” again as compared to three months the first time. “i was back at the gym doing spin classes and eating and drinking again — all in a short amount of time,” she happily recalls. Schepisi attributes a quicker recovery to having an epidural for pain management after the second surgery versus more powerful post-operative medications given after the first procedure. kennedy was more than pleased. “There’s no formal study on this, but i believe a positive attitude and outlook are important and are associated with an easier recovery,” says the surgeon. Schepisi was offered systemic chemotherapy after both procedures — anti-cancer medication designed to circulate throughout the entire body instead of just a targeted area. She decided against it both times. “For low-grade appendiceal cancer, it’s less known if systemic chemotherapy provides a survival benefit. We do know this follow-up treatment provides some benefit and improves survival for those with more aggressive cancers like colorectal and gastric. it’s really a quality of life issue,” notes kennedy. Schepisi is on a schedule to follow up with kennedy and team every few months, and she’s not on any medication. married 31 years in October 2016, Schepisi and her husband “put a lot of things on hold” while she endured each leg of her cancer journey, but she knows life is good. “my quality of life is great. i really can’t complain,” Schepisi notes. She’s been keeping up with the gym and going on vacation. The couple even took in a recent Bruce Springsteen concert complete with limo and dinner — overall, just taking things “one day at a time.” I Autumn 2016 I W hile pre-surgical assessment through a tiny incision can be uti- lized to determine which patients will benefit from cRS and HiPec, kennedy says it’s not common to do cRS and HiPec through a minimally invasive approach unless the disease is very limited. mostly, patients have extensive disease throughout the peritoneal area. With that, an incision is made at the top of the abdomen down to the pelvic region. The aim, says the surgeon, is to achieve complete cytoreduction — either no disease or having all tumors remaining under 2.5 millimeters. The debulking — or surgical procedure to remove disease — can take four to 12 hours on its own. Some of this time can be spent just getting through scar tissue, but much of it involves peritonectomy procedures and intestinal re-connections following the removal of any involved organs. kennedy approaches each case by dividing up the needed surgical removals into multiple, smaller operations. One thing he believes is unique to his technique is that he tries to focus on disease removal and spares affected organs as much as he can. “it may be be easier to remove an entire organ, but that could lead to a poor quality of life for the patient or risk of complications,” he shares. kennedy also tries to limit the number of bowel connections to limit complications and risk of infection. Following the actual surgical debulking, catheters are placed in the abdomen and the abdomen is stitched closed. Subsequently, saline is administered into the abdominal cavity and heated to 107 degrees. The chemotherapeutic agent is then added. mitomycin c is given in most HiPec procedures, as this particular drug doesn’t absorb in the body as much as other chemotherapies that might cause toxicity to organs at high doses. The heated solution is then manually agitated through the cavity using a pump that is monitored by specially trained circulating nurses. kennedy notes the heat is important, as it’s been shown that cancer cells are more sensitive to heat, thus more of them are destroyed. He adds HiPec requires a comprehensive team, from nurses and scrub techs, to pharmacists, uro-oncologists, gynecologic oncologists, and plastic/reconstructive surgeons. Perfusion specialists who handle the chemotherapy pumps are key, as well as a nutritionist Cancer Connection I 19