Cytoreductive surgery is a surgical procedure used to remove tumors from patients with peritoneal mesothelioma. When it’s paired with hyperthermic intraperitoneal chemotherapy (HIPEC), it considerably increases life expectancy and reduces the rate of cancer recurrence.
Benefits of Cytoreduction with HIPEC
Improved Prognosis: In some cases, cytoreduction with HIPEC has resulted in patients living longer than 7 years after their diagnosis.
Better Quality of Life: Those who have this procedure report less symptoms and pain, allowing them to live more fulfilling lives.
Cytoreduction is a procedure that aims for the complete removal of all visible tumors affecting the protective lining of the abdomen. The cytoreductive procedure itself is complex and can last anywhere from 10 to 12 hours.
According to Dr. Paul Sugarbaker, the developer of cytoreduction with HIPEC, there are up to 5 surgical procedures surgeons may have to combine to achieve the complete removal of peritoneal mesothelioma.
Which and how many of these procedures are used is determined by how far the mesothelioma has spread throughout the abdominal cavity.
The five procedures include:
- Anterior parietal peritonectomy: This surgery removes the diseased fat pad in the front of the stomach. It can also be used to remove scar tissue from old abdominal surgeries.
- Left upper quadrant peritonectomy: Removes the greater omentum (the largest fold of the inner peritoneum) and spleen.
- Right upper quadrant peritonectomy: Removes tumor growth on the liver.
- Pelvic peritonectomy: Removes parts of the uterus, ovaries or large intestine.
- Omental bursectomy: Removes parts of the gall bladder and part of the peritoneum between the stomach and liver.
Because cytoreduction is complex and can last for an extended period of time, only an experienced mesothelioma specialist can perform the procedure effectively.
During cytoreductive surgery, the surgeon uses a tool called an electrosurgical hand piece to remove mesothelioma tumors. The hand piece is beneficial because it generates an intense amount of heat via high-voltage electricity and burns diseased tissue at the edges of incision.
Burning the edges of the incision prevents stray cancer cells from being pushed away into the abdomen as the incision is made. This ultimately helps prevent the mesothelioma tumor from growing back from stray cancer cells after the surgery is completed.
Hyperthermic Intraoperative Chemotherapy (HIPEC)
After the surgical procedure is completed, the surgeon introduces a heated, sterile solution mixed with chemotherapy drugs into the abdominal cavity.
The solution is heated to 104 – 107 degrees and allowed to circulate for a maximum of two hours.
Heating the solution to a high temperature and allowing it to circulate for an extended amount of time boosts its effectiveness. The extra time and high temperature allow for maximum absorption of the chemotherapy into the cancer cells. Better absorption limits the exposure of the chemotherapy to healthy tissue surrounding the tumor and lowers the side effects typically associated with traditional chemotherapy.
After the procedure, patients are required spend an average of 2 weeks in the hospital. Nurses monitor vital signs throughout the patient’s stay and make sure that no post-surgical complications occur.
Discomfort is common after surgery, especially around the incision. The doctor will prescribe medication to help ease the pain and will usually recommend only light, gentle activities, like washing the dishes or dusting, during the first 4 weeks after surgery.
Patients are required to revisit the hospital for a check-up between 4 to 6 weeks after the procedure. If there are no further complications, the patient can resume normal activities after the check up.
Risks and Benefits
Cytoreductive surgery is a complex, invasive procedure. Like most surgeries, it carries the possibility of complications, including:
- Abnormal heartbeat (arrhythmia)
- Blood clots
Patients can take steps to prevent some of the complications that may arise during their recovery. Walking as soon as possible after the surgery can help prevent blood clots from forming in the legs. Taking medication prescribed by a physician controls nausea and vomiting, which can put stress on a patient’s abdominal incision and slow the healing process.
Untreated, peritoneal mesothelioma would normally spread throughout the stomach and intestines, causing blockages and making it difficult for patients to eat. Cytoreductive surgery with HIPEC offers the best chance for patients to increase their life expectancy by removing the cancerous tumor completely.
A recent study on cytoreductive surgery with HIPEC reported amazing results with a median overall survival rate of 5 years. In fact, a few of the patients who took part in the study survived 7 years and beyond.
Researchers are continuing to advance the combination of these two treatments in large, long-term studies and clinical trials. Another recent study reported that cytoreductive surgery paired with HIPEC using a specific, platinum-based chemotherapeutic drug, called carboplatin, is associated with better survival rates and shorter periods of recovery time.