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Peritoneal Mesothelioma Surgery with HIPEC Can Trigger Blood Cell Problems

peritoneal mesothelioma surgery and HIPEC

More than half of patients who have peritoneal mesothelioma surgery with HIPEC develop problems with their blood cells afterward. That’s the finding of a team of cancer researchers from Singapore. 

The group analyzed 15 years worth of data on peritoneal mesothelioma surgery outcomes. They found that, even though the procedure saves lives, it can be risky. 

Older patients and those who had prior chemotherapy were most likely to develop hematological toxicities after peritoneal mesothelioma surgery. 

Hematological Toxicities and Mesothelioma Treatment

Hematological toxicities are problems with the cells that make up the blood. This can include white blood cells, red blood cells, platelets, and proteins involved in bleeding and clotting. 

Several drugs that kill mesothelioma cells can cause blood cell problems. Peritoneal mesothelioma patients usually have chemotherapy. They may receive these drugs in multiple ways. 

Some patients have systemic chemotherapy before peritoneal mesothelioma surgery. This is called neoadjuvant chemotherapy. Its goal is to shrink the tumor before surgeons remove it.

Many peritoneal mesothelioma patients also undergo HIPEC. HIPEC is heated intraperitoneal chemotherapy. It is an intense inter-operative chemotherapy treatment that kills residual cancer cells.

The combination of cytoreductive surgery (CRS) and HIPEC has improved peritoneal mesothelioma surgery outcomes. 

Blood Cell Problems Common After Peritoneal Mesothelioma Surgery

Blood problems after peritoneal mesothelioma surgery can be serious. Some hematological toxicities can even be life threatening.

Researchers at Singapore’s National Cancer Centre wanted to find out how often these problems occur. They also wanted to know which ones are the most common.

They analyzed 220 CRS/HIPEC patients from 2001 to 2016. The study included patients with mesothelioma or another type of abdominal cancer.

Fifteen percent of patients developed leukopenia after surgery. Leukopenia is a dangerous drop in infection-fighting white blood cells called leukocytes.

Just under four percent of patients developed neutropenia. This is a drop in neutrophils, another type of white blood cell.

The most common blood problem after peritoneal mesothelioma surgery was thrombocytopenia. This is a low platelet count. When the body does not have enough platelets, it cannot form clots. More than 37 percent of patients developed this problem after surgery.

The problems usually developed within a few days of surgery and lasted for as long as 16 days. Patients over 60 and those who had systemic chemotherapy before surgery had the highest risk for hematologic toxicities.

The researchers say these patients should be closely monitored after surgery for signs of blood cell problems.


Wong, EYT, at al, “Hematological toxicities associated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy”, November 6, 2019, Asia-Pacific Journal of Clinical Oncology, Epub ahead of print, https://onlinelibrary.wiley.com/doi/abs/10.1111/ajco.13275

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