how do you actually pick a surgeon for HIPEC? what should I be asking

I'm in almost the exact same boat, same plant same era, diagnosed last month. The volume thing is absolutely real and it's not just people saying it. I looked at the literature before I picked anyone and the difference between surgeons doing 5-10 HIPEC cases a year versus 30-40 is pretty stark in terms of complication rates and overall survival.

When I called around I asked three things right off. First, how many cytoreductive HIPEC cases have they personally done in the last two years. Not their team, them specifically. Second, what's their CC-0 rate, which is the completeness of cytoreduction score. If they're not immediately telling you they aim for CC-0 that's a problem because that's the whole ballgame. Third, what's their major complication rate and are they transparent about it. Anyone who gets defensive or vague is a no from me.

I had my first consultation at a surgeon here in Cleveland who was recommended and honestly the red flag was that he didn't ask much about my symptoms or my timeline. Just started talking about the procedure. I drove up to Ann Arbor to see someone at the university there who actually spent time understanding where my distension started and how fast things progressed, which matters for staging decisions. He had done about 60 HIPEC cases in the last three years and the complication data he shared matched what I'd read in the Annals of Surgical Oncology.

Ask them about their HIPEC protocol too, especially the temperature and the chemotherapy agents they use. Most use mitomycin C but some protocols vary. And ask what their follow-up imaging schedule looks like because that tells you if they're actually monitoring for recurrence or just assuming you're fine.

The Detroit place, make sure you ask them all three of those questions and don't be shy about asking for their published outcomes if they have any. Good luck with the consultation.

Yeah I'd def ask them straight up how many of these they do a year and what their complication rates actually are, not the glossy stuff. The surgeon I went with for my EPP wasn't some big name place but he'd done like 200+ of em and could talk specifics about his own numbers without the corporate speak.

Yeah man, this is exactly the kind of thing where you gotta kick the tires before you buy the car. I'm peritoneal too, stage I, but I had the EPP surgery back in February so different beast than HIPEC. But I learned a ton about finding the right surgeon.

Here's what I did. First I called Cleveland Clinic back and asked who they work with on the peritoneal side specifically, not just who takes their referrals. That matters because some surgeons do a little bit of everything versus the ones who eat and sleep this stuff. Then I got on the phone with the surgeon's office and straight up asked how many HIPEC cases they do a year. If they can't give you a number or seem vague about it, that's a red flag. Real programs know their numbers. We ended up going to someone who does like 40-50 a year, not 5.

When I met with my guy I asked about his complication rates, yeah, but I also asked what his plan was if something went sideways during the surgery. That tells you if he's thought through the worst case or if he's just gonna wing it. Ask about their HIPEC drug protocol too, some centers use different chemo mixes and they should be able to explain why they chose theirs. Also ask how long they keep patients in the hospital post-op because that varies and frankly tells you something about their confidence level.

The Detroit option isn't bad but honestly if you're stage II and the numbers matter that much, don't be afraid to travel. We drove to Ann Arbor for the consult even tho we're in Detroit, and it was worth it. The surgeon I saw had published papers on peritoneal cases which felt like okay this guy actually cares about the outcome data not just the paycheck.

One thing nobody tells you - bring your imaging with you on a USB drive or whatever. Watch how seriously they look at YOUR specific scans versus just the pathology report. That's when you can tell if they're customizing or just running the playbook like you said.

Good luck with this, sounds like you're asking the right questions...

Joe went through this exact thing back in October when his oncologist at Moffitt Cancer Center here in Tampa said he needed a surgeon for potential cytoreduction. I'm not gonna lie, it was overwhelming trying to figure out who actually knew what they were doing versus who just had the equipment.

What really helped us was asking about their case volume specifically. Not just "how many have you done" but "how many THIS YEAR" because that matters. The surgeon Joe ended up with at MD Anderson had done over 200 HIPEC procedures and could talk through complication rates without hesitating. He said something like 15-20% of his patients had post-op complications but his infection rate was lower than the national average, and he could back that up with actual data.

When you go to your Detroit consultation, I'd ask them straight up what percentage of their HIPEC patients needed reoperation within 30 days. If they get uncomfortable or vague that's a yellow flag. Also ask about their mortality rate for the procedure itself, not just complications. And honestly? Ask if you can talk to someone who had it done by them. We did that and it made all the difference hearing from an actual patient about recovery and what to expect.

The thing about major centers is they do see more complex cases so the patients there tend to be sicker overall, which can skew the numbers either way. But volume absolutely matters because this isn't a standard surgery. It takes real expertise. Joe's surgeon spent like 45 minutes just reviewing his scans before the consultation even started, asking questions about his symptoms timeline and what imaging showed.

How are you feeling about the Detroit place so far?