finding a surgeon who actually knows multimodal therapy for peritoneal meso

Cytoreductive surgery is the real deal for peritoneal, yeah. Ask them straight up how many HIPEC cases they do a year and if they coordinate the chemo sequencing with their oncology team before surgery, that'll tell you everything you need to know.

Yeah man, I'd also ask if they do the HIPEC right there in the OR or if they ship you somewhere else for it, because some places farm that out and that's a red flag IMO. Good catch on the sequencing thing though, that's the tune-up that actually matters.

yeah man that's exactly what I'm dealing with too, except mine was pleural so different beast but same headache trying to figure out who actually knows their stuff versus just going through the motions. I'd say ask them straight up how many of these procedures they do a year and if they work with a specific oncology team on the chemo timing, that tells you pretty quick if they're coordinating or just swinging the knife on their own.

Hey, I gotta be honest with you - pleural's what I got so I'm not gonna pretend I know peritoneal inside and out. But I went through the surgeon vetting thing back in February when I needed my EPP, so maybe some of that translates.

First thing I did was call MD Anderson in Houston and just asked straight up "who on your team does the most cytoreductive surgery for peritoneal cases." The person I talked to actually knew the answer off the top of her head, which told me they see enough of it to know. When a place has to go hunting for that info, that's a yellow flag. Your oncologist probably has relationships with surgeons already, so ask her directly which centers she'd send her own family to for peritoneal HIPEC. Don't make her guess. Make her pick one.

The sequencing question you're asking is the right one. My surgeon at the time talked through with my chemo team about timing, drug interactions, all that. That coordination matters way more than any one person's credentials. When I called places, I asked "walk me through how your surgeon and oncology department communicate during treatment planning" and listened for whether they actually had a system or if it sounded improvised.

Cytoreductive surgery is real terminology, not made up. It means they're trained specifically to debulk tumors aggressively, which is different from general surgical oncology. Not every good surgeon does it routinely. If someone's doing HIPEC, they should know that term and not have to ask what you mean.

How many procedures matters but the number that matters is like 50+, not 5+. I asked my surgeon straight up "how many EPP's have you personally done" and he said 127. That was worth knowing. You're not wasting time asking that.

You're stage II with three months of getting worse, so yeah, move fast but not stupid. Good luck with this.

Look, I'm pleural not peritoneal so take that into account, but the vetting process was the same headache for me back in June. Here's what actually mattered when we were calling around.

First thing, ask them straight up how many multimodal cases they've done in the last two years. Not total in their career. Last two years. Places that are legit about this will have a number ready. We called MD Anderson and they said 47 in 2024. Called another center and they hemmed and hawed which told us everything.

The surgeon coordination piece you're asking about is real. My surgical team at VAMC Norfolk coordinated with my oncology folks before my pleurectomy in August. They literally sat down together. So when you call, ask if the surgeon meets with oncology before they schedule you. Not after. Before. If they say "oh the oncologist will handle that part" then you probably keep calling.

Cytoreductive surgery is the right term and yeah it matters for peritoneal cases especially. It's the debulking work they do before HIPEC. Different skill set than pleural work honestly. Pleural is one thing but stripping peritoneum and managing visceral surfaces, that's another animal. Ask them if they've done cytoreductive cases specifically, not just "abdominal surgery."

Neoadjuvant versus adjuvant timing... this is where you actually need to see their protocol on paper. Not just what they tell you. Ask for their standard approach in writing. That's a fair ask and legit places will have it documented. We got ours from my surgical team, showed it to a second opinion surgeon at another hospital in September.

You're not wasting time being thorough. You've got stage II which gives you some runway but yeah, don't drag your feet once you pick the right place.

Pleural and peritoneal are pretty different animals, I'd focus on someone who specifically does peritoneal cases routinely. Ask them straight up how many HIPEC procedures they've done in the last year and whether they work with a dedicated oncology team on the sequencing, that'll tell you real quick if they're just dabbling or actually running a program.

So Joe's diagnosis was pleural, not peritoneal, but we went through something similar with finding the right surgeon for his cytoreductive approach combined with immunotherapy. I can't speak to the exact same sequencing you're dealing with but the vetting process... yeah, that matters a lot.

When we called around, the thing that actually stuck with me was whether the surgeon could explain HOW they work with the oncology team. Like, we talked to one place in November 2025 where the surgeon's office basically said "we do the surgery and your oncologist handles chemo" and that felt off to me. Then we got on a call with someone else and within five minutes they were talking about tumor burden, what chemo Joe would be on before surgery, what the scan timing looked like. That person knew Joe's case before we even got there because they'd actually reviewed his films with the oncology team. That's the difference.

The HIPEC question is smart. We asked about volume and also about what the actual failure points are. Like, a surgeon who's doing this routinely will tell you not just the numbers but also what they've learned about complications, what imaging they use to plan, whether they have a perfusionist on staff. If someone gets vague about the technical details that's... not great.

On pleural versus peritoneal, I think you're right that it matters. The anatomy is different, the drug delivery is different with HIPEC. Cytoreductive surgery is the right term and it means they're trained specifically in removing tumor from multiple organs and peritoneal surfaces. That's not the same as general oncologic surgery.

Your instinct about protocol sequencing is exactly right. The 2024 studies on peritoneal cases do show timing matters. Ask them point blank: what's your standard approach with neoadjuvant versus adjuvant, and more importantly, why? The answer will tell you if they're following current literature or just doing what they've always done.

You're not wasting time by being careful about this. You caught it at stage II which is actually... you're in a decent spot to be selective about your team.