A new study finds that organ resection during CRS/HIPEC surgery does not shorten peritoneal mesothelioma survival and may even help prolong it.
The new research included 174 peritoneal mesothelioma patients from cancer centers across the country. These patients had cytoreductive surgery followed by heated intraperitoneal chemotherapy (CRS/HIPEC).
About half of the patients also had at least one organ removed to help prevent mesothelioma recurrence. The goal of the new study was to determine what impact, if any, this practice has on peritoneal mesothelioma survival.
The answer appears to be, not much.
CRS/HIPEC and Peritoneal Mesothelioma Survival
About 20 percent of mesothelioma patients have the peritoneal variety. This type of mesothelioma occurs on the lining of the abdomen and can easily spread to other abdominal organs.
CRS/HIPEC is the gold standard treatment for this rare cancer. During the procedure, surgeons remove the diseased peritoneal membrane and other at-risk tissues.
After surgery, they rinse the abdomen with a mix of heated chemotherapy drugs. The drugs are supposed to help kill any remaining cells to keep them from seeding new mesothelioma tumors.
A number of studies indicate that CRS/HIPEC can improve peritoneal mesothelioma survival. But there is not much data on the survival impact of removing other organs besides the peritoneal membrane. That was the goal of the new study.
Resection of Other Organs During CRS/HIPEC
Cytoreductive surgery (CRS) aims to remove all visible mesothelioma tumors in the abdomen.
If mesothelioma has spread beyond the peritoneum, surgeons may also remove part of the diaphragm, stomach, spleen, pancreas, small bowel, colon, rectum, kidney, ureter, bladder, and/or uterus.
To see what impact these removals have on peritoneal mesothelioma survival, researchers divided patients into three groups. The first group included 94 patients who only had their peritoneal membrane removed. The second group included 45 patients who had one other organ removed. In the third group were patients who had two or more other organs removed during CRS/HIPEC.
The researchers compared peritoneal mesothelioma survival across the three groups. The risk for major complications was similar. Hospital stays were just one or two days shorter for mesothelioma patients who had no additional organs removed.
The researchers concluded that a higher rate of major organ resection (MOR) did not shorten survival.
“MOR was not associated with an increase in major complications or worse overall survival in patients undergoing CRS/HIPEC for malignant peritoneal mesothelioma,” writes study author David Roife of the Moffitt Cancer Center in Tampa.
Removing organs infected with mesothelioma cells might even improve peritoneal mesothelioma survival. The more complete the cytoreductive surgery is, the lower the likelihood of new tumors.
The researchers conclude that organ resection “should be considered, if necessary, to achieve complete cytoreduction for MPM patients.”
Roife, D, et al, “CRS/HIPEC with Major Organ Resection in Peritoneal Mesothelioma Does not Impact Major Complications or Overall Survival: A Retrospective Cohort Study of the US HIPEC Collaborative”, October 18, 2020, Annals of Surgical Oncology, https://link.springer.com/article/10.1245/s10434-020-09232-9