multimodal therapy and finding a surgeon who actually knows what they're doing

Man I feel you on this. When I got my Stage I pleural diagnosis back in December I thought I'd done my homework but then you realize there's homework and then there's actually knowing what you're looking at, you know?

So here's what happened with me. I found a surgeon at U of M who had done EPP surgery on mesothelioma cases and I asked him point blank how many he'd done in the last three years. Not lifetime, last three years. He said 47 and then he walked me through his actual protocol with the medical oncologist, showed me the calendar, showed me when chemo started relative to surgery. That specificity meant something. It wasn't just a number, it was proof he had a system. I had my surgery in February and recovery's been solid so far.

For your HIPEC question I'd ask them the same way. Don't let them give you vague stuff. Ask them how many peritoneal cases specifically, what their complication rates actually are broken down by type, and whether the oncologist who'll be giving you chemo before and after is literally in the same building or if it's gonna be phone tag between two hospitals. That coordination piece is real. My surgeon and oncologist were on the same team and it made a huge difference with timing.

The five year survival thing without stage breakdown is a red flag honestly. That's like a mechanic telling you he fixes cars real good without saying whether he's talking about oil changes or transmissions. Stage II is different than Stage IV so you need numbers that match your actual situation.

And traveling for the right surgeon beats staying local for the wrong one. I'd rather drive to Ann Arbor than wonder if I made the right call.

Hey, so here's what I learned the hard way. I had my EPP surgery back in February with a surgeon at University of Michigan and what actually mattered wasn't just his case numbers, it was whether he could explain to me in plain English how he was coordinating with my oncologist on the chemo timing. Like I sat down with both of them together before surgery and they literally mapped out the schedule on a whiteboard. My oncologist in Detroit, my surgeon in Ann Arbor, they were texting back and forth after my surgery about when to start the tune-up. That felt real to me, you know? Not just a name on a consultation form.

The thing that surprised me was asking the surgeon directly about his complication rates, not just survival numbers. I asked what percentage of his peritoneal patients needed a second surgery or had major infections and he didn't dodge it. Some surgeons get kinda vague with that stuff and that's a red flag. You want someone who says "here's what can go wrong and here's how we handle it when it does."

One more thing that helped me, I called the chemo nurses at the hospital where he operates and asked them off the record which surgeons their docs actually work well with. Nurses know who communicates and who doesn't. They were honest in ways the marketing materials never are.

I'm in almost the exact same position as you right now, which is both comforting and kind of terrifying if I'm honest. Diagnosed November, Stage II peritoneal, and I've been living in spreadsheets trying to figure out who actually knows what they're doing versus who just has a reputation.

The case volume thing that keeps getting thrown around, I looked into this pretty carefully. What matters is specifically the cytoreductive surgery plus HIPEC cases, not just general surgical volume. One surgeon I consulted with had done over 200 procedures but when I dug deeper, a lot of that was other stuff. When I asked about their specific peritoneal mesothelioma cases with HIPEC in the last three years, the number dropped significantly. And yes, breakdown by stage matters enormously. A surgeon can look great on five year survival if they're mostly doing earlier cases.

On the team coordination piece, I've been asking directly whether the medical oncologist will be involved in the surgical planning before I go in, not after. The ones worth considering have already had me talk to both sides. One center in Ohio actually had me do a video call with the surgeon and the chemo doctor together to talk through the sequence. That felt different than the others. And regarding whether they need to be at the same place, I've read that it's manageable if they're separate but honestly the places where it's all under one roof seem to have less friction. You're already in Cleveland so you might have some decent options without traveling, but don't let location be the deciding factor if the fit isn't right.

What I've started asking specifically: what's their protocol if complications happen post-op and they need to adjust the chemo timing? That question has revealed a lot about who's actually thought this through versus who's just checking boxes.

Are you looking at Cleveland Clinic or University Hospitals for your initial consultations?

hey, I really respect that you're doing this homework. Joe went through something similar trying to figure out who to trust with his treatment plan and honestly it was one of the most stressful parts of the whole thing.

So here's what I learned from our experience. When we were vetting surgeons, the ones who actually seemed to know their stuff weren't just rattling off numbers. They wanted to talk about Joe's specific scans and pathology, not just give us a generic pitch. One surgeon we consulted with in November 2025 actually pulled up imaging with us and walked through exactly how he'd approach the cytoreduction, talked about what he'd expect to find. That felt different from the others who kind of gave us the highlight reel.

The team coordination thing you mentioned... yeah that matters way more than being at the same physical location I think. Our medical oncologist is at Cleveland Clinic but Joe's surgical team ended up being different people, and what made it work was actual communication. Like documented conversations before surgery about chemo timing, what the oncologist wanted to see happen during the procedure. We asked specifically "will you two talk before he goes into surgery" and that was a yes or no question that told us a lot.

On the stage II thing, I'd push on the timing question too. Ask them how they typically sequence chemotherapy before versus after HIPEC, and ask what the rationale is. If they can't explain it clearly or if it seems like they're just doing whatever is standard, that's different from someone who's thought through the logic for your particular case.

The survival stats without stage breakdown would bug me too. That's kind of a teacher thing for me, I guess... if someone can't show their work, it's hard to trust the answer.

How are you feeling about the options you're looking at so far?

Joe's doing immunotherapy right now and I've learned that the coordination piece you're asking about is everything, honestly. When his oncologist and surgeon actually talk to each other before treatment starts, it changes how they plan the whole thing.

Hey, I'm so glad you're doing this research upfront. My mom is Stage III pleural so it's a different beast, but I've watched her go through the surgeon selection process and honestly it's been one of the most stressful parts of this whole thing.

What I noticed with her team at Banner in Phoenix is that the medical oncologist literally sits in on the surgical consultations. Like, they're both in the room talking about timing and what chemo makes sense before versus after. When we initially consulted with someone who wasn't at the same institution, it felt... looser? Like we'd have to be the messengers between two separate offices and that terrified me because I don't have the medical knowledge to know if they're actually aligned or just being polite to each other.

The case volume thing that everyone throws around, I get why you're frustrated with it. We asked about specific peritoneal HIPEC cases and the surgeon actually pulled up their last three years of outcomes by stage. That felt real to me because they could talk about the actual patients without being weird about it, and they could say which ones did well and which ones didn't. The surgeon who just gave us a number and moved on? We didn't go back to them.

One thing my mom's oncologist mentioned in August when we were first figuring this out was that the coordination between pre-op chemo, surgery timing, and post-op chemo is literally where the multimodal approach lives or dies. It's not just that they do all three things, it's that they've done it together enough times to have a rhythm. Does that make sense?

If you can get to one of the bigger centers even for a second opinion, I think it's worth the trip. We spent like $400 on flights and hotels to go to Banner and it completely changed what we understood about her options. Cleveland has good hospitals so you might be fine locally, but the mesothelioma world is small enough that there are definitely centers that are known for this specifically.

You're asking exactly the right questions. The fact that you're this thorough already puts you ahead of where a lot of people are.