Surgery for peritoneal mesothelioma requires a delicate approach, mostly due to the organs in the abdominal cavity. Cytoreduction, the main life-saving operation for this cancer, involves manually removing visible tumors.
If any tumors engulf an organ, surgery becomes more challenging. Most doctors fear the consequences of taking out the spleen, pancreas, colon, kidney or something else.
A recent study proves that you can remove one of these organs if needed — and it won’t affect patient survival.
The Annals of Surgical Oncology published the report, which analyzes 174 patients who received cytoreduction with heated intraperitoneal chemotherapy (HIPEC). This combination of surgery and chemotherapy is the most beneficial option for people with peritoneal mesothelioma.
Cytoreduction involves bulk removal of all visible tumors. HIPEC delivers liquid chemotherapy into the stomach to kill the remaining tumors. Even with this combination, 100% eradication of the disease is difficult, especially if tumors have reached organs.
The solution? Major organ resection should be done, if necessary.
“(Organ resection) was not associated with an increase in major complications or worse (overall survival) in patients undergoing (cytoreduction with HIPEC),” the report stated.
Which Organs Can Doctors Remove During Cytoreduction?
Peritoneal mesothelioma forms in the thin lining that wraps around the abdominal cavity. This lining, called the peritoneum, is often overrun with tumors by the time patients undergo surgery. Doctors remove the peritoneum during cytoreduction.
They also look for noticeable tumors in the abdominal cavity and carefully remove the diseased tissue. The operation requires caution due to the number of organs in the abdomen, such as the:
- Small and large intestines
In the study, 80 of the 174 patients had at least one organ partially or totally removed. The organs resected were the:
- Small intestine
- Large intestine (colon or rectum)
Effects of Removing an Organ to Treat Peritoneal Mesothelioma
Pleural mesothelioma often involves removing an affected organ. This form of the cancer originates near the lungs, which puts one or both at risk of tumor infiltration. One of the leading surgical options is a lung-removal surgery called extrapleural pneumonectomy.
As of now, peritoneal mesothelioma treatment mostly steers clear of removing an organ to address a bulk of tumors. That’s why the peritoneal cancer index (PCI) score is so critical when determining treatment.
PCI applies a score to the scope of the cancer within the abdominal cavity. Each of the cavity’s 13 regions gets a score between 0 and 3 (0 meaning no disease is present, and 3 meaning the section is overrun with tumors).
The scores are added up, often determining if the patient should have surgery. The higher the score, the more likely tumors have invaded at least one organ.
The average PCI score in this study was 16, which is equivalent to a stage 2 or stage 3 cancer. People with a higher score likely needed an organ removed.
In the study, patients with an organ removed had a slightly higher frequency of complications. However, the rates of serious complications were similar. The length of hospital stay following surgery increased by just one day for patients who had an organ removed.
Most telling is the decreased survival rate for people who had an “incomplete cytoreduction.” That result is often due to not removing an organ infected by tumors. Willingness to take out these organs leads to fewer cases of incomplete cytoreduction.
Most important is finding a cancer center with a peritoneal mesothelioma specialist. Doing so will put you in the safest hands for your surgery. Email our patient advocate and registered nurse, Karen Ritter, at firstname.lastname@example.org for help finding a hospital.
Sources & Author
- 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. Annals of Surgical Oncology. Retrieved from: https://link.springer.com/article/10.1245/s10434-020-09232-9. Accessed: 10/22/2020.
Sources & Author