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Peritoneal Mesothelioma and Palliative CRS/HIPEC Surgery

Peritoneal Mesothelioma and Palliative CRS/HIPEC SurgeryPeritoneal mesothelioma is 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 many different factors. Surgical oncologists at the Medical College of Wisconsin are studying this question.

Considering Surgery for Palliative Intent?

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) have changed that. CRS involves removing as many of the cancer cells as possible. After surgery, the abdomen is cleaned with heated chemotherapy drugs to kill residual cancer cells. The more complete this process is, the better the patient outcome.

But not every patient is a good candidate for CRS/HIPEC. There are many different factors. Surgical oncologists at the Medical College of Wisconsin are studying CRS/HIPEC symptoms.

They want to know how patient symptoms and outcomes improve from CRS/HIPEC. The team from Milwaukee looked at patients undergoing CRS and/or HIPEC between 2008 to 2018.

The team looked at patients who underwent surgery with palliative intent. The goal of palliative intent surgery is to increase a patient’s quality of life. Palliative intent surgery is intended to relieve painful symptoms.

Promising Data for Mesothelioma Surgical Decisions

There are other medical and procedural options for palliative intent surgery. Some clinicians hesitate to use CRS/HIPEC as a palliative treatment. But the data says that CRS/HIPEC has comparable survival rates to other major oncologic surgeries.

Patients who were included in the study had different types of abdomen cancers. This included all patients with peritoneal mesothelioma.

The bad news? The postoperative complication rate was 50%. This means that half the patients had a complication after surgery. Yet only 20% of patients experienced a major complication.

The good news? A full 90% of patients reported partial symptom improvement or a full resolution of symptoms. The average time to symptom recurrence was 5.1 months. And the average patient survival was 11.6 months.

Data published in the Journal of Surgical Research gives hope that palliative CRS and/or HIPEC achieve symptom improvement.

Peritoneal mesothelioma is most common in people who worked in an industry that exposed them to asbestos. Clinicians recommend that patients do a risk assessment before making the decision. And the expected time to recover from the surgery also remains an important factor.

CRS and/or HIPEC for a palliative intent can be effective in relieving symptoms of advanced peritoneal mesothelioma.


Strong, Erin A., Austin Livingston, Maciej Gracz, Wendy Peltier, Susan Tsai, Kathleen Christians, T. Clark Gamblin, Karen Kersting, and Callisia N. Clarke. “Palliative Cytoreductive Surgery With or Without Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis: Is It Safe and Effective?.” Journal of Surgical Research 278 (2022): 31-38. https://doi.org/10.1016/j.jss.2022.04.012

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