how do you actually know if a doctor is good at this stuff? picking my surgeon

The fact that you're asking this after a solid recovery probably means you did okay, but yeah, second opinions are smart with EPP - that's not distrust, that's just due diligence on a procedure that aggressive. Ask about their complication rates and whether they do multimodal treatment (surgery plus chemo plus sometimes radiation) because the good ones integrate all three, not just slice and dice.

Got my diagnosis June 2025 at the VA screening in Norfolk and had my pleurectomy at Duke in August. Surgeon there had done over 200 cases and that number mattered to me but here's what actually told me more. He spent 45 minutes going through my scans with me point by point explaining what he was seeing and what he wasn't seeing. My first oncologist just said "yeah you need surgery" and moved on. Big difference.

The university program thing is real. Those places have protocols and they're doing this stuff constantly so they catch complications faster. But confidence alone doesn't mean squat. I've served under plenty of confident officers who couldn't navigate a harbor in daylight. What you want is confidence backed up by the actual case load and the willingness to explain their reasoning to you like you're not an idiot.

Second opinion wasn't weird at all. I got one at MD Anderson and my Duke surgeon didn't take it personally. He said anyone with stage II should get at least two sets of eyes on it. The fact that you were thinking about it means you were doing the right thing. This isn't about trust it's about verification. Navy taught me that... never assume one set of readings is enough.

Recovery solid is good news D. That's what counts right now. You can't change the decision you made but you can focus on the healing part which sounds like you're already doing.

The fact that you're asking these questions after a solid recovery actually tells you something, but yeah, case volume combined with institutional affiliation matters more than either one alone. Second opinions are never weird, especially with EPP - that's the kind of surgery where getting it right the first time is everything.

I'm still in the evaluation phase myself so I haven't had surgery yet, but I've been doing a lot of research on this exact question. Volume matters but you're right that it's not the whole story. What I've found is that you want to know specifically how many HIPEC procedures they've done, not just general mesothelioma cases. Those numbers are wildly different. A surgeon doing 20 HIPECs a year is not the same as someone doing 3.

The university affiliation is actually significant. There's a 2022 study in the Annals of Surgical Oncology that showed peritoneal meso patients treated at high-volume centers had better median overall survival, around 57 months versus 35 at lower-volume places. But "high-volume" was defined as centers doing more than 10 cases annually, which honestly isn't that many. Your Ann Arbor surgeon probably fits that category if he's part of a university program.

I asked my potential surgeon about his complication rates and what percentage of his patients needed reoperation within 30 days. That felt like a real question instead of just asking if he's good. He actually had those numbers ready, which made me more confident. Also asked about his mortality rate and whether he uses hyperthermic perfusion or normothermic, because there's literature suggesting hyperthermic might have some advantages though the data's still evolving.

Don't feel weird about second opinions. I'm getting one at MD Anderson before I commit to anything, and when I told my local oncologist he basically said he'd do the same thing. This is your abdomen we're talking about. You're allowed to be thorough.

The fact that you had solid recovery and no major complications suggests you probably did pick well. That's not luck, that's usually the result of a surgeon who knows how to manage the procedure and the aftercare.

Yeah man I get it, that's the thing that keeps you up at night isn't it. So here's what I figured out after the fact. My guy at U of M, Dr. Saffir, had done like 80 some EPPs before mine and he was real specific about what he'd seen go wrong with other surgeons. Not bragging, just matter of fact. Like he pulled up scans from other hospitals and explained why his approach was different for my particular lung situation. That felt real to me, not just confidence but like he could back it up with actual reasoning.

The second opinion thing, dude I totally did that. Went to another place in Ohio in January before my surgery and honestly it made me feel way better about choosing the first guy. And you know what, the second opinion doc said the same things basically but explained it different, so it clicked in my brain that my first surgeon wasn't just selling me something. Getting a second opinion isn't disrespect, it's just smart. I told my surgeon straight up I was doing it and he was cool with it. If he'd gotten weird about that I probably would've been sus.

The university program thing matters more than you'd think. They see more cases so they've dealt with weird complications, plus they're teaching so they gotta stay sharp. Regional hospitals might have good surgeons but they're doing one every couple months instead of like a dozen a year. That's a big difference when someone's cracking open your chest.

Recovery's going solid for you which is honestly the best sign you could get right now. How you feeling energy-wise these days?