A method of delivering heated chemotherapy drugs to the abdomen after the surgical wound has been closed may produce better outcomes than an open technique for fragile or elderly mesothelioma patients.
The study was conducted by surgery departments at three different Greek hospitals. Study subjects included 105 patients with either mesothelioma or another peritoneal malignancy. All of the patients were recommended for cytoreductive surgery to remove as much of their cancer as possible followed by a rinse of heated chemotherapy drugs at the site of the surgery (HIPEC) to kill any residual cancer cells and prevent recurrence.
Sixty of the patients with mesothelioma or another cancer received HIPEC using an open abdomen technique. In this technique, the chemotherapy solution is rinsed through the abdomen while the surgical wound is held open. The remaining 45 patients received HIPEC through several tubes inserted through the abdominal wall after the surgical incision had been closed up.
Twenty-two (55%) of the patients who underwent the open HIPEC procedure developed serious complications afterward and two died shortly after the procedure. In the closed group, 18 patients (40%) had serious complications but none died. The biggest difference between the two techniques appeared to be in their impact on blood flow; central venous pressure, pulse rate, and systolic blood pressure were all reported to be lower in the closed group than the open group.
The results prompted the study’s authors to conclude that the closed method may be the method of choice for the frailest patients with abdominal cancers like mesothelioma because of its “more stable hemodynamic parameters.” Their conclusions appear in a recent issue of the International Journal of Surgical Oncology.
Cytoreductive surgery followed by HIPEC has become a popular method for treating peritoneal mesothelioma, an aggressive asbestos-linked cancer that starts on the peritoneal lining of the abdomen and can spread easily to other abdominal organs. Control of mesothelioma with either the open or closed technique has been shown to be about the same.
Halkia, E et al, “Peritoneal Carcinomatosis: Intraoperative Parameters in Open (Coliseum) versus Closed Abdomen HIPEC”, February 15, 2015, Epub ahead of print, International Journal of Surgical Oncology