Overview

Cytoreductive surgery (CRS) involves removing all visible tumors from the abdominal cavity. It is the primary surgical treatment for peritoneal mesothelioma and is almost always combined with heated intraperitoneal chemotherapy (HIPEC) to kill any remaining microscopic cancer cells.

Who May Be a Candidate

  • Peritoneal mesothelioma patients
  • Limited disease spread (PCI score typically <20)
  • Good overall health (ECOG 0-1)
  • No distant metastases
  • Epithelioid cell type preferred

How It Works

The surgeon systematically examines the entire abdominal cavity and removes all visible tumor deposits. This may include removal of affected organs or organ linings (peritonectomy). After maximum tumor removal, heated chemotherapy is circulated throughout the abdomen.

Procedure Steps

  1. Midline abdominal incision
  2. Complete exploration of abdominal cavity
  3. Assessment of disease extent (PCI score)
  4. Removal of all visible tumor (peritonectomy procedures)
  5. Removal of affected organs if necessary
  6. HIPEC administration for 60-90 minutes
  7. Abdominal closure

Benefits

  • Can achieve complete visible tumor removal
  • Combined with HIPEC provides excellent local control
  • Significantly improves survival for peritoneal mesothelioma
  • Some patients achieve long-term remission

Risks & Side Effects

  • Major surgery with significant morbidity
  • Bleeding
  • Infection
  • Anastomotic leaks
  • Prolonged recovery
  • Kidney or liver effects from HIPEC

Recovery

Hospital stay is typically 10-14 days. Full recovery takes 2-3 months. Patients often need nutritional support initially. Return to normal activities is gradual.

Expected Outcomes

Combined CRS/HIPEC achieves median survival of 53-92 months in optimal candidates. Some centers report 5-year survival rates of 50% or higher. Complete cytoreduction is the most important predictor of long-term survival.

Finding Treatment

This procedure is typically performed at specialized mesothelioma treatment centers with experienced surgical teams. Consulting with a mesothelioma specialist is the first step in determining if this treatment is appropriate for your situation.

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