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Mesothelioma Surgical Decisions: New Method May Make Them Easier

ByAlex Strauss

mesothelioma surgical decisionsCancer researchers in India and the UK have come up with a method for making better mesothelioma surgical decisions.

The group focused on peritoneal mesothelioma, the second most common form of asbestos cancer. Peritoneal mesothelioma affects the membrane around the abdominal organs. It can spread throughout the abdomen. 

Some peritoneal mesothelioma patients get good results with cytoreductive surgery. But success depends on a number of factors such as how far cancer has spread and where mesothelioma tumors are located.

The new decision-making tool reminds doctors of five important factors to consider when making mesothelioma surgical decisions for the best outcomes. It is based on the acronym PAUSE.

Peritoneal Mesothelioma and the Promise of CRS/HIPEC

Malignant mesothelioma is an especially aggressive cancer. The two primary types are pleural\ and peritoneal. Peritoneal mesothelioma used to be considered just as lethal as the more common pleural mesothelioma. 

But cytoreductive surgery (CRS) and intraperitoneal chemotherapy (HIPEC) has changed that. CRS involves removing as much of the cancer as possible. After surgery, the abdomen is rinsed with heated chemotherapy drugs to kill residual cancer cells. The more complete the cytoreduction, the better the outcome. 

But not every patient is a good candidate for CRS/HIPEC. To make mesothelioma surgical decisions, doctors consider the type and extent of the cancer and the patient’s overall health among other things. 

The new report from India’s Christian Medical College and Basingstoke Hospital in the UK aims to make the decision making process both easier and more effective.

Acronym for Mesothelioma Surgical Decisions

The new report suggests that mesothelioma surgical decisions be based on the acronym PAUSE. PAUSE stands for five key factors that help determine how likely it is that mesothelioma surgery will go well for a particular patient.

PAUSE stands for:

  • Peritoneal cancer index [how much cancer is in the abdomen]
  • Ascites [fluid buildup] and abdominal wall disease 
  • Unfavourable sites of involvement
  • Small bowel and mesenteric disease 
  • Extraperitoneal disease [cancer outside the peritoneal membrane]

In an article in Insights Into Imaging, the creators of PAUSE say the tool could become an important tool for mesothelioma surgical decisions. 

“Despite limitations of CT in accurately depicting the volume of disease, describing findings in terms of PAUSE plays an important role in excluding patients who might not benefit from CRS and HIPEC,” they write. 

Peritoneal mesothelioma is most common in people who worked in an industry that exposed them to asbestos. Some common industries include construction and construction trades, manufacturing, mining, firefighting, shipbuilding and shipbreaking. 

Source: 

Chandramohan, A, et al, “Communicating imaging findings in peritoneal mesothelioma: the impact of ‘PAUSE’ on surgical decision-making”, November 24, 2021, Insights into Imaging, https://insightsimaging.springeropen.com/articles/10.1186/s13244-021-01118-y

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