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Mesothelioma Cytoreduction with HIPEC

Cytoreduction with HIPEC the main surgery for people with peritoneal mesothelioma. The procedure surgically and chemically removes cancer from the abdomen. Patients live much longer after having this surgery.

What is Cytoreduction with HIPEC?

Cytoreduction and HIPEC is the best treatment for peritoneal mesothelioma. Cytoreduction means reducing the number of cancerous cells. HIPEC stands for “heated intraperitoneal chemotherapy.”

Peritoneal mesothelioma is cancer of the abdominal lining. It often spreads into other organs in the abdomen. Cytoreduction removes the peritoneal lining and tumors found in the abdomen. Heated chemotherapy washes the inside of the abdomen. This helps kill remaining mesothelioma cells.

Creation of Cytoreduction with HIPEC

Cytoreduction with HIPEC was developed in the 1980’s. Dr. Paul Sugarbaker perfected the procedure as we know it today. It’s often referred to as the “Sugarbaker Procedure.”

Heated chemotherapy used to be controversial. The survival time for peritoneal mesothelioma also used to be between 6 and 12 months before HIPEC. Doctors have perfected the procedure over the years. Most started to recognize its importance for peritoneal mesothelioma patients as survival times climbed.

“[Cytoreduction] and HIPEC then quickly became the treatments of choice, with an improvement in median overall survival of 30 to 92 months,” said doctors in a clinical review of the surgery.

Patient Eligibility

Not everyone is a candidate for cytoreduction and HIPEC. There are certain criteria patients must fulfill before they get this surgery. The criteria is meant to protect patients. Only patients with a low chance of complications are accepted for surgery. A multidisciplinary team of mesothelioma specialists will review each case before surgery.

People who are candidates for cytoreduction with HIPEC have:

  • Good overall health (ability to go about daily life without help)
  • No signs of other major disease
  • Normal heart function
  • No major metastasis (spread to other areas of the body)

Doctors access these basic criteria with performance tests and imaging scans. The most important factor is how advanced your disease is. Surgery isn’t as helpful in advanced peritoneal mesothelioma.

Some pre-surgery tests you may expect include:

  • CT and PET scans. These scans can locate instances of metastasis. If cancer has spread to distant areas, surgery is more likely to hurt than help you.
  • Echocardiogram. This test uses sound waves to measure heart function. It’s critical for surgical candidates to have a healthy heart to endure the long operation.
  • Performance tests. Doctors may measure how long you can exercise while measuring your heart rate and blood pressure. They may also consider your body mass index.
  • Blood tests. These tests ensure you have an appropriate red blood cell count. This is important for any surgical patient.
  • Laparoscopy. This procedure uses a camera placed through a small incision to locate tumors. Surgeons may want to examine the extent of tumors before opening the abdomen.  

Patients under the age of 65 are usually operable. But older patients may not be candidates in some cancer centers. If age affects your treatment options, consider a second opinion. Many specialists consider overall health more important than a patient’s age.

Did You Know?  Most doctors think HIPEC is more effective than traditional chemotherapy. “HIPEC allows for a higher concentration of chemotherapy to be delivered into the abdomen more effectively and safely than standard chemotherapy,” said Dr. Sricharan Chalikonda of the Cleveland Clinic.

Cytoreduction with HIPEC Procedure

Cytoreduction with heated chemo is a long procedure. It takes a team of specialists and roughly 8 hours. This is because the abdomen is complex with many organs.

Cytoreduction is a two-stage procedure that includes:

  • Cytoreductive surgery (debulking). The cytoreductive surgery is also called debulking. First a surgeon makes an incision in the abdomen. Then they remove the peritoneum. This is the lining of the abdomen. The surgeon removes visible tumors in the abdominal cavity. Your surgeon may also remove certain organs like the appendix.
  • HIPEC. Next, heated chemotherapy agents are applied to the abdominal cavity. There they are in a good position to kill off any remaining mesothelioma cells. Heated chemotherapy is left in the abdomen for up to 90 minutes. 

Chemotherapy works better in direct contact to cancer cells compared to an injection of the drug. Heated chemotherapy even cells that can’t be seen with the naked eye. Some studies suggest that chemotherapy agents are more effective when heated.

Patients who have this procedure don’t often get follow-up chemotherapy right away. Treatment after HIPEC depends how and when your mesothelioma progresses.

Patients who receive multiple cancer treatments (surgery, chemotherapy and radiation therapy) usually live longer. They may also have a better quality of life when compared to people who have only one or two different types of cancer treatment.

Patients usually spend between 7 and 15 days in the hospital. Doctors check your vitals to prevent complications from surgery. After this you are allowed to go home to finish healing.

Your doctor will order checkups several times a year to check on the state of your mesothelioma.

Extended Life Span with HIPEC

Cytoreduction and HIPEC vastly improves survival time. Many patients live long past the five-year mark even when they were diagnosed with advanced stage disease. In one study, the survival time in patients increased by 50 percent compared to those who didn’t get HIPEC.

The procedure has been successfully performed in patients with early and advanced stages. It can be used for curative and pain-relieving purposes.

If you are receiving treatment in the VA, check with your specialist about the cytoreduction with HIPEC. It’s also important to find out how many of these procedures they have done.

Getting Cytoreduction with HIPEC

Cytoreduction with HIPEC offers the best chance for peritoneal patients to reach remission. Those who don’t have surgery are unlikely to have long-term survival. Peritoneal mesothelioma patients are reaching median survival times of 7 years in some cases.

Points to remember about cytoreduction with HIPEC:

  • Patients who get this surgery must be in good health.
  • You could be eligible for surgery if your disease hasn’t metastasized.
  • Patients who get HIPEC have survival times of several years.

If you’re considering this surgery, you need a mesothelioma specialist. There are peritoneal mesothelioma surgeons across the country who can help. Get your free Mesothelioma Veterans Guide now and learn more.

Sources & Author Edited: September 1, 2015

About the Writer

Senior Veteran Support Team

The Mesothelioma Veterans Center was created to provide information and assistance to veterans regarding treatment, clinical trials, and VA benefits for veterans suffering from asbestos illnesses. The MVC was founded by retired veterans and veterans advocates who have helped hundreds of veterans get approved for their VA benefits after developing mesothelioma or asbestos-related lung cancer from their asbestos exposure in the military.

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