Clapper, Patti, Schweizer and Mason

Selecting a qualified doctor who specializes in mesothelioma is only part of the battle that  patients must face when confronting this horrible asbestos cancer.  Next comes plotting out a course of treatment and then, if that treatment plan includes surgery, finding a qualified surgeon and hospital at which to have the procedure completed.  Data collected and analyzed in a new review of multimodal treatments for various forms of cancer shows that low-volume hospitals have much lower post-surgical survival rates than high-volume hospitals.

The study, authored by three researchers from the Melanoma and Sarcoma Unit of the Veneto Institute of Oncology or the Department of Oncological and Surgical Sciences at the University of Padova, in Padova, Italy, was originally focused on determining the effectiveness of cyto-reductive surgery combined with hyperthermic intra-peritoneal chemotherapy (HIPEC).  This multi-modal mesothelioma treatment uses tumor reduction surgery to reduce the tumors in combination with with direct application of chemotherapy drugs.  However, during the course of their research, the three authors discovered an alarming disparity in death rates at various hospitals. 

The researchers found that this dual approach used as a treatment for peritoneal mesothelioma, colorectal cancer, gastric cancer, and other diseases had an average mortality rate of 17%.  That’s about on par with other forms of aggressive abdominal surgery.  However, upon segmenting the data they found that that rate actually fluctuated between 12% and 52% depending on the individual hospital.

The study revealed that low-volume hospitals which saw fewer patients and performed fewer surgical procedures had higher mortality rates for this and other surgical treatments because the complex surgeries had a fairly sharp “learning curve.” 

In addition to lower success rates and higher mortality, low-volume hospitals experienced higher morbidity rates (rates of disease—including abscesses, fistulas, perforations, anastomotic leaks and ileus—related to the surgical procedures) than high-volume hospitals. 

These relatively high rates can be offset by proper pre-surgical screening.  The researchers stress that correctly pre-qualifying each patient through CT and PET scans along with laparoscopic exploration is absolutely necessary.  Some cancer patients—especially mesothelioma patients—may not be suitable for this type of aggressive surgery. 

Certain aspects of malignant mesothelioma or pre-existing health conditions may drastically increase the risk of an adverse event including death.  Therefore, the reviewers concluded that proper application of a sliding scale, such as the Peritoneal Cancer Index, to define the scope of the individual cancer case as accurately as possible can not only help classify patients but may also enable more accurate prediction of post-surgical results.

Though the risks of this type of procedure are high, mesothelioma is an aggressive cancer, especially peritoneal mesothelioma.  Without treatment, patients can expect to live roughly 12.5 months after diagnosis.  This short lifespan can be quadrupled to 53 months in many cases by undergoing a multimodal surgical/chemotherapy treatment.  Indeed, the data collected in Italy shows that 47% of patients who survive the initial surgery live at least five years—a milestone for mesothelioma patients.