So I'm at the point where I need to make a decision about HIPEC surgery and I'm realizing that not all surgeons are the same, obviously, but I'm struggling to figure out what actually separates someone who does multimodal therapy well versus someone who just says they do it.
I got my diagnosis in November and I've been doing research for about six weeks now. I worked at the Johns-Manville plant in Cleveland from 1978 to 1985 in insulation manufacturing, so I have a clear exposure history and that's helping with the legal side of things. But the medical side is what's eating at me right now.
Here's what I'm trying to figure out: when a surgeon says they do multimodal therapy, what should I actually be asking them? I keep seeing case volume numbers thrown around but I'm not sure if that's the real metric that matters. Is it the number of HIPEC procedures specifically? The number of peritoneal cases? How recent are their outcomes? One surgeon I talked to mentioned their five year survival rate but didn't break it down by stage and that felt... incomplete.
I'm also trying to understand the coordination piece. Like, do they have an actual team approach where the medical oncologist and the surgeon are talking before and after, or is it more fragmented than that? I read a study out of Brigham that suggested the timing of chemo relative to surgery matters significantly but I don't know how to assess whether a given center actually has that dialed in.
And maybe this is obvious but I'm asking anyway: does the surgeon need to be at the same institution as your chemo team, or is it OK if they're separate as long as they communicate? I'm in Cleveland so I'm looking at some bigger academic centers but I'm also considering traveling if it makes sense.
I have my symptom journal here and my pathology report is peritoneal mesothelioma, Stage II, which my understanding is that HIPEC is worth serious consideration. I'm trying to make an informed decision and not just pick a name I recognize.