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Cytoreductive Surgery and Chemotherapy Improved for Mesothelioma

Published: April 7, 2023

Improvements have been made for cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC). This treatment combination is typically performed on people with cancers in the abdominal region. One such cancer is peritoneal mesothelioma. Peritoneal mesothelioma is a cancer of the lining of the abdomen caused by asbestos exposure. Peritoneal mesothelioma is second to pleural mesothelioma in terms of new cases every year. CRS/HIPEC involves removing peritoneal mesothelioma tumors from the body before heated chemotherapy drugs are circulated throughout the abdominal cavity. The combination of surgery and chemotherapy is useful because it removes tumors and the chemotherapy kills any cancer cells that may be left behind.

Chemotherapy is normally administered intravenously. This allows chemotherapy drugs to circulate throughout the body where they can kill cancer cells. HIPEC is different because when it is administered, chemotherapy only comes in contact with the abdominal cavity. Heated chemotherapy drugs are circulated with a pump so the drugs can come in contact with tumors. Heated chemotherapy is more effective because healthy cells die at 111.2 degrees Fahrenheit compared with cancer cells that die at 104 degrees Fahrenheit. When circulated throughout the cavity, the temperature is high enough to kill cancer cells while still cool enough to protect healthy cells.

CRS/HIPEC was once very invasive. After the treatment was finished, patients needed to stay in the hospital for a long period of time to rest. When the surgery is performed now, patients can go home much sooner due to the surgery being much less invasive. Doctors use robotic surgery, which is much more precise than typical surgical procedures. Studies show that when robotic surgery is used, patients have better outcomes including a reduction in blood loss and time it takes to complete surgery, which helps lower the impact surgery has on the  body.

Despite improvements in the surgery, CRS/HIPEC is still recommended only for patients in good enough health to receive surgery who have had their cancer diagnosed early. If more advances occur in this specific surgery and chemotherapy combination, more patients could possibly benefit. More clinical trials need to be performed to improve the treatment. This would not only improve survival but improve quality of life as well.

Joanna Ortega et al., “The robotic future of minimally invasive cytoreduction and hyperthermic intraperitoneal chemotherapy for peritoneal surface malignancies” Chin Clinical Onlology (2023). [Link]
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