Getting a Second Opinion at an Expert Center May Change Your Treatment Options
- Jul 20
- 2 min read
Joseph EA, Khan MMM, Lewis C, Bartlett DL, Wagner PL, Allen CJ. Characteristics and Outcomes of External Referral Patients Undergoing Cytoreductive Surgery at an International Peritoneal Surface Malignancy Program. Ann Surg Oncol. 2026 Jul 18. doi: 10.1245/s10434-026-20115-3. Epub ahead of print. PMID: 42471490.
Key Takeaway: Being told your cancer is "inoperable" may not be the final answer. This study found that many patients who were initially considered unable to undergo cytoreductive surgery (CRS) at another hospital were able to receive successful surgery after evaluation at a high-volume peritoneal surface malignancy (PSM) center.
Why This Study Matters
For patients with cancers that have spread to the lining of the abdomen (the peritoneum), surgery is one of the most important treatments when it is possible to remove all visible disease. However, determining whether someone is a candidate for cytoreductive surgery (CRS), often combined with HIPEC (heated chemotherapy), requires specialized expertise.
Researchers wanted to understand what happens to patients who are referred to an expert peritoneal cancer center after being treated—or told they were not surgical candidates—at another hospital.
What the Researchers Found
The study compared patients who came directly to a specialized peritoneal cancer center with those who first received care elsewhere.
Among patients referred from outside hospitals:
71% had previously been told that complete surgery was not possible.
Some had never been offered surgery, while others had surgery that was stopped because the cancer appeared too extensive or only an incomplete operation could be performed.
After evaluation by an experienced multidisciplinary team at the expert center, 85% of these patients ultimately underwent complete cytoreduction (CC0)—meaning surgeons were able to remove all visible cancer.
Another 10% were able to receive surgery to help relieve symptoms, even if cure was not possible.
Although these referred patients often had more advanced disease and required more extensive operations, many still benefited from treatment at a specialized center.
What This Means for Patients
One of the most important messages from this research is that an initial opinion is not always the final answer.
Peritoneal cancers are uncommon, and determining whether CRS and HIPEC are possible depends on many factors, including:
The amount and location of cancer
The specific type and biology of the tumor
The experience of the surgical team
The resources available at the treating center
High-volume peritoneal cancer centers often have multidisciplinary teams with extensive experience evaluating patients who may appear inoperable elsewhere. Other experts have also emphasized that referral to these centers should occur early, rather than only after chemotherapy options have been exhausted.
The Bottom Line
If you or a loved one has been told that surgery is not an option for cancer that has spread to the peritoneum, consider seeking a second opinion at a specialized peritoneal surface malignancy center.
This study demonstrates that many patients who were previously considered inoperable were ultimately able to undergo complete removal of their visible cancer after evaluation by an experienced CRS/HIPEC team. While not every patient will become a surgical candidate, a second opinion from experts in peritoneal malignancies can provide additional treatment options and help ensure every possibility has been explored.
