Study Examines Efficacy of Peritonectomy and Chemotherapy for Peritoneal Mesothelioma

Surgery combined HIPEC

Peritoneal mesothelioma is a form of mesothelioma that develops in the abdomen. The only known cause of the disease is exposure to asbestos. In order to improve patient survival, one of the most common methods of treatment for peritoneal mesothelioma includes using a form of heated chemotherapy during surgery.

A recent study in India examined the efficacy of two different methods of peritonectomy combined with chemotherapy for peritoneal mesothelioma. Previous clinical trials noted success in combining this type of surgery with heated chemotherapy, extending patient survival. In this latest study, researchers sought to compare the two methods of peritonectomy. In doing so, they observed patients’ life expectancy and quality of life.

Study Finds Complete Peritonectomy Most Effective in Treating Peritoneal Malignancies

Patients with peritoneal mesothelioma and other abdominal cancers may undergo a peritonectomy as part of treatment. This is a surgery that removes the lining of the abdomen (peritoneum).

The surgery may be performed as a complete peritonectomy, which consists of removing the entire parietal peritoneum, including cancerous and non-cancerous portions. It can also be performed as a partial peritonectomy, which removes only the cancerous portion of the peritoneum.

Both methods of peritonectomy are often used in combination with a type of chemotherapy called hyperthermic intraperitoneal chemotherapy (HIPEC). This is a standard treatment for peritoneal mesothelioma that involves applying heated chemotherapy into the abdominal cavity.

A study conducted at the Manipal Comprehensive Cancer Center in India tested the efficacy of both methods of peritonectomy combined with HIPEC. The combination treatment was administered to patients with peritoneal malignancies, including peritoneal mesothelioma. Researchers aimed to assess the remission and survival rates of both sets of patients to determine which surgery was more effective over the course of four years.

One group of 70 patients underwent a complete peritonectomy. A group of 93 patients underwent a partial peritonectomy. Both groups of patients were administered HIPEC after surgery.

When comparing patient groups, doctors identified higher risks in undergoing a complete peritonectomy. Data showed surgeons spent an average of two hours longer completing a complete peritonectomy than a partial peritonectomy. Further, patients who underwent complete removal lost 1.2 liters of blood, which was twice as much as partial removal surgeries.

Results also showed risks in undergoing a complete peritonectomy, including a longer hospital stay. However, despite these risks, researchers concluded a complete peritonectomy is more effective due to its associated long-term benefits.

Complete Peritonectomy Proves Favorable in Long-Term Results

Research indicated patients experienced more favorable outcomes in life expectancy by undergoing a complete peritonectomy. Researchers also noted complete peritonectomy led to a lower risk of cancer recurrence, or detection of cancer after a period of time.

Researchers found:

  • Complete peritonectomy patients were recurrence-free for an average of five months longer than partial peritonectomy patients. The median recurrence-free survival for complete peritonectomy patients was 26 months.
  • The partial peritonectomy patient group saw a 3-year survival rate of 60%. Patients who underwent a complete peritonectomy had an average 3-year survival rate of 80%.
  • On average, 42% of partial peritonectomy patients survived four years or longer, compared to 80% of complete peritonectomy patients.

While the complete peritonectomy poses an increased risk of complications, data showed its long-term efficacy was more favorable than the partial peritonectomy.

Not all patients are eligible for this surgery, as patients with stage 3 or stage 4 cancer may be in poor health and unable to withstand the potential side effects. However, a complete peritonectomy may be a viable option for patients with stage 1 or stage 2 peritoneal mesothelioma, as the tumors are typically localized to the peritoneum.

Although the study shows a promising multimodal treatment, patients should discuss viable treatment options for their individual case with their healthcare team. This can help them better understand the benefits and risks of each procedure.