Peritoneal mesothelioma is a rare condition with only 400 cases diagnosed every year. Patients diagnosed with the cancer are not living as long as they could because of the underutilization of surgery. Surgery is only performed on a third of patients even though there are people that would benefit and qualify for it. When patients undergo surgery to remove peritoneal mesothelioma, they live much longer than people who do not.
A surgical study found that those undergoing surgery lived longer lives. Patients who did not have surgery had an overall survival of 7.1 months compared to 38.4 months for people who underwent surgery. Patients lived longer if they added chemotherapy with a 41.8 month survival rate and even longer with hyperthermic intraperitoneal chemotherapy with a 65.9 month survival rate. Only 34 percent of patients in the study underwent surgery while 15 percent of patients underwent minimal surgery. Some patients do not qualify for surgery because of age or disease progression, but the majority of cases can actually undergo surgery. One problem is that not many doctors specialize in the procedure, so patients do not have access to the right surgeon to get the job done.
The reason that patients cannot receive surgery is that many surgeons equate peritoneal mesothelioma with pleural mesothelioma, which is a hard disease to treat. It is hard to treat because not many patients qualify for surgery to help them and the median overall survival is not long for pleural mesothelioma. Another problem is that there are not many peritoneal mesothelioma patients, so doctors may not train to specifically treat peritoneal malignancies, so many of them do not know how to properly treat the cancer and do not know how to surgically remove it.
Peritoneal mesothelioma is successfully treated with hyperthermic intraperitoneal chemotherapy after surgery. The chemotherapy kills cancer cells left behind after the majority of cancer is removed. The chemotherapy is heated and then circulated through the abdominal cavity to kill any remaining cancer. Unfortunately, not many cancer treatment centers perform this treatment. Treatment can also take a long time, between 6 to 12 hours to fully complete. Since the treatment is one of the most effective, more cancer centers need to train their doctors to do HIPEC chemotherapy and surgery to treat a greater number of patients. If people are diagnosed, they need to see properly trained surgeons for the best chance at long term survival.
L Bijelic et al., “Predictors and Outcomes of Surgery in Peritoneal Mesothelioma: an Analysis of 2000 Patients from the National Cancer Database” (January 31, 2020). [Link]