There’s hopeful news for peritoneal mesothelioma patients facing the prospect of surgery. A new study on the benefits of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) finds that both the process and outcomes have improved over time.
Cytoreductive surgery refers to any surgery aimed at removing as much cancerous tissue as possible. With peritoneal cancers such as mesothelioma, the surgeons may follow the procedure with a wash of heated chemotherapy drugs into the open body cavity. The goal of HIPEC is to destroy any remaining mesothelioma cells and to help keep new mesothelioma cells from growing.
A study of 1,000 cytoreductive surgery/HIPEC patients, 72 of whom had mesothelioma, found that complications have decreased and survival has increased for all of the conditions studied from 1991 to 2013. Thirty-day mortality from the procedure for the entire study period was 3.8% and the median hospital stay was 8 days. But patients treated most recently, when the institution had the most experience, did best overall.
“The data show that outcomes have improved over time, with more complete cytoreduction and fewer serious complications, transfusions, and stomas,” the authors report in the Journal of the American College of Surgeons. “This was due to better patient selection and increased operative experience.”
Mesothelioma patients who are good candidates for cytoreductive surgery and HIPEC include those who are in good overall health, have early stage mesothelioma confined to one area, and have the epithelioid variety of the disease. If patients are carefully selected and their hospital is experienced with cytoreductive surgery/HIPEC, the researchers say the outlook is better than ever. “Cytoreductive surgery with HIPEC represents a substantial improvement in outcomes compared with historical series, and shows that meaningful long-term survival is possible for selected carcinomatosis patients,” they write.
The study was presented at the Southern Surgical Association’s annual meeting in Virginia in December. Because it focused on procedures performed at just two institutions (Wake Forest University School of Medicine and Creighton University School of Medicine), the researchers say multi-institutional cooperative trials are needed to refine the use of cytoreductive surgery and HIPEC for mesothelioma and other cancers.
Levine, EA, “Intraperitoneal Chemotherapy for Peritoneal Surface Malignancy: Experience with 1,000 Patients”, December 21, 2013, Journal of the American College of Surgeons, Epub ahead of print.