Ekaterina Baron, MD, Surgical Oncology, Institute for Cancer Care at Mercy Medical Center talks about her study of predicting aborted HIPEC procedures in appendiceal cancer patients. This important work can help surgical oncologists improve patient selection for HIPEC procedures.
I want to talk a little bit about the research that you conducted about the patient selection for the HIPEC procedure. Could you tell me why this was an area of interest?
Dr. Baron: Our study was about patient selection for the HIPEC procedure. HIPEC is an aggressive and specific treatment for stage four cancers where the metastases have spread throughout the whole abdomen. During the surgery, all tumor must be removed. Then, the abdomen is washed with heated chemo to kill the remaining cells which can only be seen microscopically. This treatment has shown very impressive results and we already know that it might even be a cure for particular patients. That is why there are many expectations and hopes for these procedures from both patients and surgeons. At the same time, it is a relatively new treatment.
What were you and your colleagues looking at in particular?
Dr. Baron: Our research was focused on the fact that not all HIPEC surgeries are successful. Sometimes surgeons need several hours of operating to realize that a tumor cannot be removed. In this case, they have to stop the surgery. It is an extremely dramatic situation because aborted surgery itself does not have any benefits for the patient and can lead to complications. Our study was focused on finding a tool that can be applied before surgery to identify the best candidates for a procedure and avoid unnecessary surgery in other patients.
What did you find that surgeons should consider when going into this surgery?
Dr. Baron: Appendiceal tumors can have different histologic subtypes and the first thing we found was that preoperative factors that are associated with an aborted procedure can be different among these subtypes. For example, in low grade tumors, which have the most favorable prognosis, we found that inflammatory markers, tumor markers, and the fact that the patient had HIPEC in the past, but now has recurrence, were associated with the aborted procedure. In contrast, for high grade tumors, which have worse prognosis, only inflammatory markers mattered. It is an interesting finding. It does not mean that if a patient’s lab tests show elevated inflammatory markers we should not do surgery, but allows surgeons and patients to think more realistically about surgical outcomes and perform additional tests, like diagnostic laparoscopy, taking additional imaging, or sometimes even waiting a little to see how the tumor will behave.
You mentioned inflammatory tumor markers. Is that a blood test or how is it measured?
Dr. Baron: Inflammatory and tumor markers are different markers that are measured with a blood test. For example, C-reactive protein is a well-known and well-studied inflammatory marker. It had never been investigated for prediction of aborted HIPEC or incomplete cytoreductive surgery. However, previous studies have shown that it can be associated with worse survival outcomes. So, it is the reason why we decided to study it for the prediction of an unfavorable surgical outcome.
Do you know how many of the procedures have been aborted once they started?
Dr. Baron: The reason why we conducted this study is an overall high rate of aborted procedures among peritoneal malignancy centers. Interestingly, it is generally stable among the major centers around the world, 20 to 30 percent. The possible cause of this high rate may be not only surgical skills or lack of HIPEC surgeons, but also in inability to remove the tumor safely due to its aggressiveness. As aborted procedures can be harmful for patients, the surgical community tries to avoid it and find out more about the patient selection process for HIPEC procedure.
What are the risks to the patient?
Dr. Baron: Aborted HIPEC procedures can be one of two types. First is when the surgeon opens and sees that the tumor cannot be removed and just stops operating and closes immediately. It is not the worst scenario because the patient has just an incision and that’s it. But, sometimes surgeons need several hours to realize that the tumor cannot be excised. By this time, they may have removed several organs or performed resections that are crucial for patients and their quality of life. At this point, once they realize that tumor is unresectable, they must stop and abort the surgery. Then, we get a situation where the patient had a really large surgery with organs removed and multiple anastomoses that will not provide any benefit to them, but will bring significant risks for complications. Also, postoperative recovery after such extensive surgery delays chemotherapy, which usually is the main treatment option for patients with unremovable tumor.
Interview conducted by Ivanhoe Broadcast News.
END OF INTERVIEW
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