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Two Cytoreductive Surgeries Can Improve Survival for Peritoneal Mesothelioma Patients

Published: April 29, 2022

If peritoneal mesothelioma patients undergo a second surgery after recurrence, they can improve their survival. Data from a retrospective review from Wake Forest Baptist Medical Center shows that cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) can be incredibly helpful for peritoneal disease sufferers. For some people, a second surgery has the ability to improve and lengthen survival. The review was recently published in the Annals of Surgical Oncology. Both the surgical oncology and biostatistics and data science departments at Wake Forest published the review. Wake Forest Baptist Medical Center is a highly acclaimed facility that deals with peritoneal cancers.

Cytoreductive surgery is a procedure that takes all visible tumor cells out of the abdominal cavity. It can take a long time to perform and is very aggressive, with the gallbladder, liver, pancreas, spleen, and intestinal tract being options for removal. HIPEC is usually used directly after surgery. It involves administering heated chemotherapy throughout the abdominal cavity to help kill cancer cells that remain after surgery.

The study looked at 156 patients from 1991 through 2021 who received cytoreductive surgery and HIPEC at least two separate times. There were 1,547 patients overall who received the treatment at least once for either appendix, colorectal, or mesothelioma cancers. The 156 patients who received the treatment at least twice primarily had appendix cancer (102) while 17 had peritoneal mesothelioma. The median survival was greatly improved from 2.5 years for patients receiving the surgery once to 10.7 years for patients who received the treatment twice. Seventeen patients received the treatment three times while four had the treatment four times. The mesothelioma patients who had the treatment at least twice had their survival improve by almost double to 67.7 months. The mesothelioma patients also saw a median overall survival of 32.2 months after the second surgery.

Surgery is still one of the best options for mesothelioma patients. If a patient is able to tolerate multiple surgeries for mesothelioma, some doctors recommend they undergo the surgeries for the best chance of survival. Peritoneal mesothelioma is a very rare cancer with only around 500 people in the United States being diagnosed every year. The rarity of this cancer makes it incredibly important to find cancer centers that specialize in hard-to-treat peritoneal cancers. Cytoreductive surgery and HIPEC are the best option for mesothelioma patients, but less than half of people diagnosed undergo this surgery because of inexperience treating the cancer. Most doctors choose to only utilize chemotherapy, which only creates an average survival of one year.

A study done by Inova Fairfax Medical Campus found that many patients do not undergo cytoreductive surgery and HIPEC, even though they could be helped and their survival could have been improved significantly. Patients can be denied because of their age, overall health, or disease progression, but peritoneal mesothelioma patients are usually not denied because of these reasons. Some doctors associate peritoneal mesothelioma with pleural mesothelioma and make their treatment decisions for pleural mesothelioma instead of peritoneal mesothelioma.

Based on the study peritoneal mesothelioma surgery does not have many complications for the first and second surgeries. Only two of the 17 peritoneal mesothelioma patients saw complications after the first surgery while three had complications from the second surgery. Two surgeries can greatly improve survival in certain patients, so it is important to go to a high-volume center so doctors can find the best candidates for pleural mesothelioma surgery.

Christian D. Valenzuela et al., “Repeat Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy for Cancers with Peritoneal Metastasis: A 30-year Institutional Experience” Peritoneal Surface Malignancy (March 14, 2022). [Link]
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