Mesothelioma Surgery with Organ Removal Extends Survival

Removing major organs to achieve a more complete cancer resection did not increase severe complications or hinder survival benefits of aggressive surgery for patients with peritoneal mesothelioma, according to a recent report.

The increased complexity of organ resection surgery will not adversely affect long-term outcomes, according to the multicenter study published in Annals of Surgical Oncology.

By comparison, an incomplete cytoreduction that can spare the organs is associated with increased mortality and shorter overall survival.

The study, which involved 174 patients across 12 specialty centers within the U.S., accentuated a growing trend that has dramatically improved the treatment of peritoneal mesothelioma in recent years.

Peritoneal mesothelioma is an aggressive cancer that starts in the lining of the abdomen and often metastasizes to surrounding organs.

A combination of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, known as HIPEC, has become the most effective way of treating it, allowing patients to survive anywhere from two to 10 years and beyond after diagnosis.

Without aggressive treatment, however, median survival is just six to 12 months.

“The results of the study were pretty consistent with what we expected to see. That’s encouraging,” co-author Dr. Sean Dineen, surgical oncologist and specialist at Moffitt Cancer Center in Tampa, told The Mesothelioma Center at Asbestos.com. “I think they really justify extensive resection, if necessary, to achieve a complete cytoreduction.”

Moffitt Cancer Center a Leader in Mesothelioma Treatment

Dineen is part of the Department of Gastrointestinal Oncology at Moffitt Cancer Center. He specializes in peritoneal diseases such as mesothelioma.

“We go into surgery knowing the operation may be extensive, but you always try to balance the extent of the surgery with the benefit the patient will receive from it,” Dineen said. “These results support going ahead with aggressive resection.”

Complete cytoreduction aims to remove all visible disease. In achieving that goal, however, resection of one or more abdominal organs may be necessary.

The HIPEC that follows involves a high-dose chemotherapy solution that is circulated throughout the abdominal cavity for 90 minutes immediately following surgery and then removed. The intent is to kill any microscopic tumor cells that evade the surgeon.

Mesothelioma Survival Rates Rising with Surgery

A slight majority of patients in the study (54%) underwent a peritoneal resection only, which involved removing the internal lining of the abdomen where the disease typically begins. That group was called MOR-0.

Another 25.9% of patients had one major organ removed (MOR-1) and 20.1% had two or more major organs removed (MOR-2) as part of their procedure.

Major organ removal was defined as total or partial resection of the diaphragm, stomach, spleen, pancreas, small bowel, colon, rectum, kidney, ureter, bladder and/or uterus.

Those organs are often where peritoneal mesothelioma has metastasized over time. The most common removals were uterus and colon.

The study found that the MOR-1 and MOR-2 groups had a higher frequency of post-surgery complications than MOR-0, but the number of major complications was similar for each group. The length of hospital stay also was slightly longer for MOR-1 and MOR-2.

Readmission rates within 90 days was not affected by MOR status. MOR was not associated with any 30-day mortality.

Median overall survival was 86 months, which included 130 months for MOR-0, 56 months for MOR-1 and 93 months for MOR-2.

The study concluded that the extent of surgery measured by MOR was not a determining factor of overall survival. A univariate analysis cited age, sex and overall health as the greatest drivers of overall survival.

Study Included Top Cancer Specialty Centers

Treatment centers involved in the study included:

• Moffitt Cancer Center, Tampa, Florida
• Johns Hopkins University, Baltimore
• Huntsman Cancer Institute, Salt Lake City
• MD Anderson Cancer Center, Houston
• Winship Cancer Institute, Atlanta
• Mayo Clinic, Rochester, Minnesota
• City of Hope National Medical Center, Duarte, California

Dineen emphasized the importance of finding a high-volume treatment center experienced with this rare cancer. Finding a mesothelioma specialist can be especially important in terms of overall survival.

“I’m biased, but when you look at the extent of the surgery frequently required, it does argue you should be at a center that has experience to do these procedures as safely as possible,” Dineen said. “The results of this study are what you should expect from a specialized center.”

The increased complexity of organ resection surgery will not adversely affect long-term outcomes, according to the multicenter study published in Annals of Surgical Oncology.

By comparison, an incomplete cytoreduction that can spare the organs is associated with increased mortality and shorter overall survival.

The study, which involved 174 patients across 12 specialty centers within the U.S., accentuated a growing trend that has dramatically improved the treatment of peritoneal mesothelioma in recent years.

Peritoneal mesothelioma is an aggressive cancer that starts in the lining of the abdomen and often metastasizes to surrounding organs.

A combination of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, known as HIPEC, has become the most effective way of treating it, allowing patients to survive anywhere from two to 10 years and beyond after diagnosis.

Without aggressive treatment, however, median survival is just six to 12 months.

“The results of the study were pretty consistent with what we expected to see. That’s encouraging,” co-author Dr. Sean Dineen, surgical oncologist and specialist at Moffitt Cancer Center in Tampa, told The Mesothelioma Center at Asbestos.com. “I think they really justify extensive resection, if necessary, to achieve a complete cytoreduction.”

Moffitt Cancer Center a Leader in Mesothelioma Treatment

Dineen is part of the Department of Gastrointestinal Oncology at Moffitt Cancer Center. He specializes in peritoneal diseases such as mesothelioma.

“We go into surgery knowing the operation may be extensive, but you always try to balance the extent of the surgery with the benefit the patient will receive from it,” Dineen said. “These results support going ahead with aggressive resection.”

Complete cytoreduction aims to remove all visible disease. In achieving that goal, however, resection of one or more abdominal organs may be necessary.

The HIPEC that follows involves a high-dose chemotherapy solution that is circulated throughout the abdominal cavity for 90 minutes immediately following surgery and then removed. The intent is to kill any microscopic tumor cells that evade the surgeon.

Mesothelioma Survival Rates Rising with Surgery

A slight majority of patients in the study (54%) underwent a peritoneal resection only, which involved removing the internal lining of the abdomen where the disease typically begins. That group was called MOR-0.

Another 25.9% of patients had one major organ removed (MOR-1) and 20.1% had two or more major organs removed (MOR-2) as part of their procedure.

Major organ removal was defined as total or partial resection of the diaphragm, stomach, spleen, pancreas, small bowel, colon, rectum, kidney, ureter, bladder and/or uterus.

Those organs are often where peritoneal mesothelioma has metastasized over time. The most common removals were uterus and colon.

The study found that the MOR-1 and MOR-2 groups had a higher frequency of post-surgery complications than MOR-0, but the number of major complications was similar for each group. The length of hospital stay also was slightly longer for MOR-1 and MOR-2.

Readmission rates within 90 days was not affected by MOR status. MOR was not associated with any 30-day mortality.

Median overall survival was 86 months, which included 130 months for MOR-0, 56 months for MOR-1 and 93 months for MOR-2.

The study concluded that the extent of surgery measured by MOR was not a determining factor of overall survival. A univariate analysis cited age, sex and overall health as the greatest drivers of overall survival.

Study Included Top Cancer Specialty Centers

Treatment centers involved in the study included:

• Moffitt Cancer Center, Tampa, Florida
• Johns Hopkins University, Baltimore
• Huntsman Cancer Institute, Salt Lake City
• MD Anderson Cancer Center, Houston
• Winship Cancer Institute, Atlanta
• Mayo Clinic, Rochester, Minnesota
• City of Hope National Medical Center, Duarte, California

Dineen emphasized the importance of finding a high-volume treatment center experienced with this rare cancer. Finding a mesothelioma specialist can be especially important in terms of overall survival.

“I’m biased, but when you look at the extent of the surgery frequently required, it does argue you should be at a center that has experience to do these procedures as safely as possible,” Dineen said. “The results of this study are what you should expect from a specialized center.”

Medically Reviewed by Top Mesothelioma Doctors

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