The risk of reduced quality of life should not be used as an argument against a new surgical technique for peritoneal mesothelioma. That is the conclusion of a team of German doctors studying the combination of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for a variety of abdominal cancers.
Peritoneal mesothelioma is a rare form of a rare disease. Arising in the peritoneum, the membrane that forms the lining of the abdominal cavity, it tends to spread quickly. The proximity of the peritoneum to other internal organs increases the chance that mesothelioma will spread. During cytoreductive mesothelioma surgery, surgeons remove as much of the diseased tissue as possible. In a growing number of centers, the procedure is followed by a wash of heated chemotherapy drugs (HIPEC) through the open body cavity to eliminate any mesothelioma cells left behind.
Although an increasing number of studies have shown the CRS/HIPEC approach to be effective at slowing the spread of cancer, it is not without risks. In addition to the risks associated with any surgery, such as pain and infection, mesothelioma patients undergoing the CRS/HIPEC treatment combination may experience cognitive impairment, fatigue, diarrhea, shortness of breath and sleep disturbances. These effects can have an impact on a patient’s emotional well-being and overall quality of life.
To determine if CRS/HIPEC was ‘worth the risk’ for patients, the German team followed ninety cancer patients, including 12 with peritoneal mesothelioma, who had undergone the procedure. They measured a list of quality of life factors both before and after surgery. The mean global health status (a measure of their overall health) of study participants was 69 prior to surgery. Although this number dropped to 55 a month after surgery, it climbed after that, hitting a high of 78 at 36 months post-surgery.
Just as importantly, what the researchers called ‘physical and role function’ recovered significantly by 6 months post-surgery and was close to the baseline again by 24 months. Emotional function was back to baseline by 12 months. Although cognitive function showed ‘slow recovery’ on follow-up, other quality of life factors generally improved after six months. In a summary of their findings published in the Annals of Surgical Oncology, the team concluded that reduced quality of life “should not be used as an argument to deny surgical therapy to these patients.”
Konstantinidis, IT et al, “Cytoreductive surgery and hyperthermic intraperitoneal chemoperfusion: The University of Arizona early experience”, June 27, 2012, World Journal of Gastrointestinal Surgery, pp. 135-140.