Carcinomatosis is a term used by mesothelioma doctors to mean that the disease’s cells are spreading within your body. When they speak of peritoneal carcinomatosis, it means mesothelioma tumors are popping up along the lining of your abdomen.
One of the treatments mesothelioma doctors have developed to combat peritoneal carcinomatosis is hyperthermic intraperitoneal chemotherapy.
Researchers from Greece have concluded that this method of fighting peritoneal mesothelioma is safe and effective. And there are ways of administering this mesothelioma treatment that make it more effective than it might otherwise be.
This is good news, indeed, because a diagnosis of peritoneal carcinomatosis typically means a short mesothelioma survival prognosis.
Writing in the 2015 volume of the International Journal of Surgical Oncology, the researchers sought to compare the open and closed methods of performing hyperthermic intraperitoneal chemotherapy.
In addition to finding that hyperthermic intraperitoneal chemotherapy — HIPEC — is safe and effective, the researchers discovered that delivering it by laparoscope offers the benefit of increased drug perfusion.
Treating Peritoneal Mesothelioma Using HIPEC
The usual method of administering HIPEC involves rinsing the abdominal cavity with a chemotherapy solution heated for one to two hours at a temperature of 107.6 degrees Fahrenheit. The chemotherapy solution most often used in HIPEC is cisplatin, the researchers report.
In the open technique, the surgeon raises the abdominal wall just enough to form a funnel. The cisplatin — or some other preferred chemoperfusate — then circulates through it.
An outflow line catches the cisplatin at the other end and pumps it back around to an inflow line at the top of the funnel. The pump also causes the solution to pass through a heater that keeps things at the proper temperature.
The closed technique involves pretty much the same arrangement, except that the abdominal wall is sealed back up before the cisplatin starts flowing.
Comparing the two techniques, the researchers report that the open type allows the cisplatin to more evenly circulate within the abdominal cavity.
The principal downside to the open method is heat loss, the researchers noted. Because the abdomen is open, the warmth easily escapes. As a result, the treatment may need to be administered longer to compensate.
Also, if the mesothelioma doctors and gathered clinicians aren’t careful, the cisplatin itself can escape the abdominal cavity and pose a toxicity threat to everyone in the operating room, the researchers cautioned.
Meanwhile, the closed technique’s main disadvantage is that the cisplatin within the abdominal cavity tends to circulate unevenly. Offsetting that drawback is the fact that the mesothelioma doctors and staff aren’t exposed to a toxicity risk and, better still, the technique is easier on frail patients.
Peritoneal Mesothelioma Patients Included in HIPEC Study
For purposes of this study, conducted retrospectively, the researchers acquired a cohort of 105 patients who were treated with HIPEC between 2009 and 2013 at various Greek hospitals.
Not all of these patients had mesothelioma. Some had colorectal cancer, while others had gastric tumors or ovarian cancer. Still others had sarcomas. Yet another subset of the cohort had a condition known as pseudomyxoma peritonei.
Of the 105 patents, 60 had received open HIPEC and the remainder — 45 in all — received closed HIPEC.
In the open HIPEC group, 55 percent suffered from grade III or grade IV complications. In the closed HIPEC group, the grade III and grade IV complications were confined to 40 percent.
“This study has shown that there are no significant differences in the postoperative morbidity and mortality with the implementation of either technique,” the researchers wrote.
They added that “Delivery of hyperthermic intraperitoneal chemotherapy can be safely performed using either the open or the closed technique, without significant difference in operative time or efficacy.”