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Length of Time Between Surgeries a Marker for Mesothelioma Survival

Peritoneal mesothelioma patients who survive more than two years after surgery are the ones most likely to benefit from a second surgery if their cancer recurs.

That is the conclusion of cancer researchers at the City of Hope Cancer Center and Wake Forest School of Medicine in an article newly published in the Journal of Surgical Oncology.

Using a City of Hope database of 1,314 patients who had cytoreductive surgery and heated intraperitoneal chemotherapy (CRS/HIPEC) between February 1993 and December 2015, the team focused on 103 patients who underwent the procedure more than once.

Fourteen of the patients (13.6%) had peritoneal mesothelioma, an aggressive malignancy that starts on the surface of the peritoneal membrane lining the abdomen. The rest of the patients had either appendiceal, colorectal or ovarian cancer-related tumors on the peritoneum.

Survival After CRS/HIPEC

Overall median survival for all patients in the study was 4.3 years.

Just over 20 percent of patients needed a repeat CRS/HIPEC procedure within a year and 38 percent needed a second operation within two years. But 42 patients with malignant mesothelioma or another peritoneal surface malignancy survived for more than two years before undergoing CRS/HIPEC again.

Although cancer eventually returned for all patients, those who went the longest without recurrence after the first surgery also ended up experiencing the longest overall survival after their second procedure.

“In multivariate analysis, the R status [a measure of the completeness of the tumor removal] and a time interval of more than two years were strongly associated with survival with each additional month between the surgeries conferring a 2.6 percent reduction in the risk of death,” writes general surgeon Ioannis Konstantinidis, MD, with City of Hope in Duarte, California.

Mesothelioma Prognosis Based on Time Between Surgeries

The CRS/HIPEC treatment combination has become the gold standard for treating peritoneal mesothelioma as well as several other kinds of peritoneal tumors. But what happens when cancer returns?

Examining the biology of a patient’s tumor is one way doctors try to determine how likely it is that a mesothelioma patient will have a good outcome after a second procedure.

Now, the authors of the new article say their study offers another way to help doctors and mesothelioma patients make more informed choices about whether or not to undergo repeat CRS/HIPEC.

“The current series validates time interval between cytoreductions as a major surrogate of tumor biology in selection of patients with recurrent peritoneal surface malignancies for repeat CRS/HIPEC,” conclude the authors.


Konstantinidis, IT, et al, “Interval between cytoreductions as a marker of tumor biology in selecting patients for repeat cytoreductive surgery with hyperthermic intraperitoneal chemotherapy”, June 12, 2017, Journal of Surgical Oncology, Epub ahead of print

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