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Peritoneal mesothelioma is the second most common type of this rare form of cancer. Pleural mesothelioma is the most common, affecting the the mesothelium of the chest cavity. Peritoneal mesothelioma, however, is the cancer of the tissue lining the abdominal cavity. As with its more common counterpart, this type of mesothelioma is difficult to treat. Patients who receive a diagnosis rarely have a good prognosis.
The treatment option that provides the best odds of remission is a peritonectomy. A peritonectomy is a surgical procedure that removes all or some of the peritoneum which is the abdominal lining. Doctors commonly combine this procedure with a type of chemotherapy called HIPEC, hyperthermic intraperitoneal chemotherapy. When used in conjunction, these strategies reduce symptoms, extend life expectancy, and increase the chance of cancer remission.
The peritoneum is the part of the mesothelium that lines the abdominal cavity and the organs inside. Mesothelioma is most strongly associated with inhaling tiny asbestos fibers, which is why the pleural form of the cancer is most common. However, those fibers may also be accidentally ingested. They may also migrate from the chest cavity to the abdominal cavity, causing tissue damage that leads to peritoneal mesothelioma.
Survival rates for peritoneal mesothelioma are not high. About one quarter of people diagnosed will live for three or more years. Treatment can extend life expectancy. If the cancer is diagnosed early, there is a small chance of a cure or remission. Perhaps the best way to achieve remission is by surgically removing cancerous tissure.
What Is a Peritonectomy?
Peritonectomy is a form of cytoreductive surgery. Cytoreductive surgery is any surgical procedure that removes cancerous tissue. The term peritonectomy refers specifically to removal of the peritoneum. However, this surgery may also remove parts of organs with cancerous tissue. Organs that may be affected are the intestines, gall bladder, liver, stomach, pancreas, or spleen.
The surgery is intended to relieve symptoms, slow progression, and achieve remission, although the latter is not always possible. To improve the odds of remission and reduce the chance of a recurrence after surgery, the procedure is often combined with chemotherapy. This combination can eliminate cancer cells the surgeon was not able to safely remove.
Hyperthermic Intraperitoneal Chemotherapy
For peritoneal mesothelioma, HIPEC is often used after surgery. HIPEC is an innovative chemotherapy method that injects heated chemotherapy drugs directly into the abdominal cavity. This differs from traditional chemotherapy which administers drugs intravenously, allowing them to curculate through the entire body.
HIPEC is proven more effective for treating peritoneal mesothelioma than the standard chemotherapy. Some studies found that treatment with HIPEC gives patients a 50 percent chance of surviving five years. This is a major achievement for treating a disease that was previously so difficult to manage. The increased survival times after HIPEC are associated with he epithelial subtype of mesothelioma.
Benefits of Peritonectomy
There are several goals of peritonectomy followed by HIPEC. These procedures aim to reduce symptoms and provide palliative care, extend survival times, achieve remission, and cure the cancer. Remission and a cure are not possible for many patients. However, those with early-stage mesothelioma have a better chance for this treatment combination resulting in long-term remission.
For most mesothelioma patients, this surgery is used to extend life. For those with advanced cancer, a benefit of peritnectomy is relief from symptoms. The removal or reduction of tumors in the abdomen can reduce pain and swelling, allowing the patient to feel more comfortable.
Risks and Complications
Peritonectomy followed by HIPEC is major surgery. While it may be less risky than radical surgeries used to treat pleural mesothelioma, it can have complications. Older patients are more likely to have complications from the surgery, but anyone is susceptible.
Possible complications include fistulas in the bowels, bile leaks, and excessive bleeding. Other complications are the same as those seen with any major surgery, including blood clots and infections. It is possible a patient will struggle to recover from this surgery only to have the cancer recur soon after.
Organ Damage and the Need for an Ostomy
An ostomy is a procedure that diverts the digestive or urinary tract to the outside of the body. The procedure creates an opening, called a stoma, that links the small intestine, large intestine (colon), or ureter to the outside of the body, bypassing the normal routes through which waste is expelled from the body.
Ostomies are typically done when the bladder or bowels cannot function normally due to disease. In rare cases, organ damage may occur as a complication of surgery. It is not a common complication, but any abdominal surgery, including a peritonectomy, may result in damage that requires an ostomy. The ostomy may be permanent or may only be temporary to allow affected tissue to heal.
Living with an ostomy presents many challenges. Patients need an ostomy bag to collect feces or urine. Because a stoma does not have a valve to shut off flow, the patient is unable to control when waste passes from the body. The constant collection of waste in a bag can cause social issues, relationship difficulties, and mental and emotional stress for the patient. Someone must also clean the ostomy regularly to avoid infection. An ostomy nurse helps patients learn to do this themselves. This is particularly important if the ostomy is permanent.
Recovery from peritonectomy varies by patient. Younger, healthier patients, as well as those in earlier cancer stages typically recover more quickly and with fewer complications. DUe to possible complications, patients must remain in the hospital after surgery and chemotherapy. Patients may receive intravenous medications, fluids, and nutrition while digestive organs heal. A tube will also drain the stomach and bowels. This is necessary until the patient is able to eat and digest normally. Recovery at home follows a hospital stay and may require bed rest until the patient is fully recovered.
Peritoneal mesothelioma is a serious and aggressive cancer. Prognosis for this illness has never been good. However, innovative treatment options have increased survival times. Cytoreductive peritonectomy surgery followed by HIPEC is an effective way to help patients live longer. For some, this procedure may even provide a cure. If you are facing treatment for peritoneal mesothelioma, know your options. Your medical team can help you understand the risks and benefits of a peritonectomy.
Page Edited by Patient Advocate Dave Foster
Dave has been a mesothelioma Patient Advocate for over 10 years. He consistently attends all major national and international mesothelioma meetings. In doing so, he is able to stay on top of the latest treatments, clinical trials, and research results. He also personally meets with mesothelioma patients and their families and connects them with the best medical specialists and legal representatives available.