A focused practice in peritoneal surface malignancy
Dr Prabhat Yaji is a surgical oncologist in Bengaluru with a specialised focus on peritoneal surface malignancies: cancers that affect the peritoneum, the lining of the abdominal cavity, or spread to it from cancers such as those of the appendix, colon, stomach and ovary.
Over his years in surgical oncology, Dr Yaji has built focused experience in these complex cancers, where treatment needs far more than removing a single tumour. Peritoneal cancer surgery needs a detailed assessment of how far the disease has spread, careful planning, meticulous cytoreduction, and an understanding of when advanced treatments inside the abdomen may be appropriate.
His approach combines this specialised surgical work with careful patient selection, team planning and a clear aim: meaningful cancer control while protecting recovery and quality of life. He practises full-time at ARC Cancer Hospital, Wilson Garden. You can read more about Dr Prabhat Yaji and his training.
Understanding peritoneal surface malignancy
Peritoneal cancers behave differently from cancers limited to one organ. Tumour deposits can spread across different areas of the abdomen and involve the peritoneum, the bowel, abdominal organs or surrounding tissue.
For selected patients, treatment may involve cytoreductive surgery (CRS), a complex operation to remove all visible tumour deposits throughout the abdomen. It may be followed by hyperthermic intraperitoneal chemotherapy (HIPEC) when it is clinically appropriate.
HIPEC delivers heated chemotherapy directly into the abdomen at the end of cytoreductive surgery. Macmillan Cancer Support describes this as chemotherapy given into the tummy during the operation. Because CRS and HIPEC can involve extensive surgery, several organs and a longer period of care around the operation, patient selection and surgical experience are critical.
- Cytoreductive surgeryAll visible tumour deposits in the abdomen are removed.
- HIPECHeated chemotherapy is delivered into the abdomen during the same operation.
- RecoveryClose care from anaesthesia, critical care, nutrition and the cancer team.
Dr Yaji’s experience in peritoneal surface oncology lets him assess these cases within the whole clinical picture, rather than looking at the peritoneal deposits on their own.
When CRS and HIPEC are considered
CRS and HIPEC may be considered for carefully selected patients when the pattern of disease, their overall health and the chance of removing the disease adequately all support it. The evaluation may include:
- The primary cancer and its biology
- How much peritoneal disease there is, and where
- The peritoneal cancer index (PCI) and the overall disease burden
- Previous surgery and chemotherapy
- General health, nutrition and fitness for major surgery
- Whether complete or near-complete cytoreduction can be achieved
Not every patient is a candidate
Not every patient with peritoneal metastases is suitable for CRS-HIPEC. The decision needs detailed imaging, pathology, a multidisciplinary discussion and a careful look at the possible benefits and risks.
HIPEC, PIPAC and evolving treatment inside the abdomen
Peritoneal surface oncology keeps evolving, with advances in cytoreductive surgery, chemotherapy given inside the abdomen, and minimally invasive approaches.
| HIPECHyperthermic intraperitoneal chemotherapy | PIPACPressurised intraperitoneal aerosol chemotherapy | |
|---|---|---|
| When it is given | During open surgery, after visible disease has been removed | During a keyhole (laparoscopic) procedure |
| How it is delivered | Heated chemotherapy directly into the abdomen | Chemotherapy as a pressurised spray |
| Who it may suit | Selected patients in whom complete or near-complete cytoreduction is possible | Selected patients who may not be candidates for complete cytoreductive surgery |
| Where it stands | An established part of treatment for selected peritoneal cancers; its role varies by cancer type | Newer; being studied and used in selected settings |
These are technically demanding treatments. When they are right depends on the disease biology, how the disease is spread, previous treatment, the patient’s fitness and the experience of the team.
Dr Yaji’s work is built around the principles needed to manage peritoneal surface malignancy carefully: knowing when aggressive surgery may help, when it may not, and how treatment should be tailored to each patient.
What to expect: the treatment process
Treatment begins well before the operating room.
Assessment
Detailed clinical assessment, imaging and pathology review to understand where the cancer started and how far it has spread.
Staging
Where appropriate, further staging or a diagnostic laparoscopy to see the disease directly.
Team decision
A multidisciplinary discussion on whether CRS-HIPEC, or another approach, is right.
Surgery
Meticulous removal of visible peritoneal disease, which may involve more than one organ or a bowel resection, followed by HIPEC where planned.
Recovery
Anaesthesia, critical care, nutrition, medical oncology, radiology and pathology all play a part in recovery from this major operation.
A balanced view
Dr Yaji believes advanced cancer treatment should never be driven by technology alone. HIPEC, PIPAC and complex cytoreductive surgery are powerful tools, but they are not right for every patient or every type of peritoneal cancer. The right treatment starts with understanding the disease and what can realistically be achieved.
Expertise means knowing how to perform a complex procedure, when to perform it, and when not to.
His practice at ARC Cancer Hospital on Hosur Main Road in Wilson Garden is within reach of patients from across Bengaluru, including Koramangala, Indiranagar, Residency Road, Richmond Road, MG Road, Church Street, Shanti Nagar, Jayanagar and JP Nagar. Cancers that commonly spread to the peritoneum are covered on the pages for colon and rectal cancer and ovarian and other gynaecological cancers.