Multi-institutional experience of diffuse intra-abdominal multicystic peritoneal mesothelioma

Our plain-English summary of Multi-institutional experience of diffuse intra-abdominal multicystic peritoneal mesothelioma, by T.C. Chua, T.D. Yan, M. Deraco, et al (The British Journal of Surgery, 2011).

The study

• Authors: T.C. Chua, T.D. Yan, M. Deraco, O. Glehen, B.J. Moran, P.H. Sugarbaker, Peritoneal Surface Oncology Group
• Journal: The British Journal of Surgery
• Published: 2011;98(1):60-4
• Cited by: 67 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: This study was undertaken to measure survival of patients with multicystic peritoneal mesothelioma treated by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy through a multi-institutional collaboration.

Methods: A multi-institutional data registry, established by the Peritoneal Surface Oncology Group, was used to identify patients with peritoneal mesothelioma and the subgroup with multicystic tumours, treated by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Outcomes for this subgroup are reported. The primary endpoint was overall survival. A secondary endpoint was the incidence of treatment-related complications.

Results: Of 405 patients with peritoneal mesothelioma, 26 (6·4 per cent) had multicystic tumours. There were 20 women and six men with a mean(s.d.) age of 42(12) years. The median peritoneal carcinomatosis index (PCI) was 14 (range 6-39). There was no perioperative mortality. Six patients developed grade III or IV complications. After a median follow-up of 54 (range 5-129) months, all 26 patients were still alive.

Conclusion: Multicystic peritoneal mesothelioma appears to be a distinct subtype of peritoneal mesothelioma, where long-term survival may be achieved through cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.

Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

In plain English

This study used a registry of peritoneal mesothelioma patients pooled by the Peritoneal Surface Oncology Group from October 1989 to February 2009. Of 405 registry patients, 26 (6.4 per cent) had multicystic peritoneal mesothelioma, a rare form of mesothelioma of the abdominal lining. All 26 were treated with surgery to remove visible tumour, followed by heated chemotherapy (cisplatin, with doxorubicin in 22 patients) delivered inside the abdomen during the operation. There were 20 women and six men, mean age 42 years. No patient died around the time of surgery. Seven had complications after surgery, six of them grade III or IV. After a median follow-up of 54 months, all 26 were alive, one with disease, and 12 had survived more than 5 years. The article did not report asbestos exposure for these patients. The authors concluded that this appears to be a distinct subtype in which long-term survival may be achieved with this treatment. They noted that it appears to involve more complications than standard debulking surgery, and considered a prospective comparison not feasible given its rarity.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective subgroup analysis of a multi-institutional patient registry (case series of surgically treated patients)
• Who was studied: 26 patients with multicystic peritoneal mesothelioma (20 women, 6 men, mean age 42 years), out of 405 peritoneal mesothelioma patients in a registry pooled from participating institutions in Australia, Italy, France, the USA, the UK and Germany, treated between October 1989 and February 2009
• Exposure: Asbestos exposure was not studied. The study examined treatment: cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy with cisplatin (50 mg/m2), with or without doxorubicin (15 mg/m2). Doxorubicin was used in 22 patients, and 3 patients also received early postoperative intraperitoneal paclitaxel.
• Main results:
  • Among the 26 patients, the median Peritoneal Cancer Index (extent of disease, scale 0 to 39) was 14 (range 6 to 39), with a mean of 17 (s.d. 9)
  • 19 of the 26 patients had no visible disease left after surgery (CC-0)
  • Seven of the 26 patients developed postoperative complications, six of them grade III or IV. There were no perioperative deaths.
  • The median hospital stay was 15 days (range 9 to 42)
  • After a median follow-up of 54 months (range 5 to 129), all 26 patients were alive. One was alive with disease and the rest had no evidence of disease.
  • Of the 26 patients, one was alive with disease at last follow-up
  • 12 patients had survived for more than 5 years. Kaplan–Meier survival analysis was not possible.
  • No clinical, pathological or treatment-related factors were associated with survival
• The authors' conclusion: The authors concluded that multicystic peritoneal mesothelioma appears to be a distinct subtype of peritoneal mesothelioma in which long-term survival may be achieved through cytoreductive surgery and hyperthermic intraperitoneal chemotherapy
• Limitations the authors state:
  • Data on previous treatments were missing for 14 of the 26 patients
  • The heated chemotherapy was not uniform across institutions: techniques, drugs, duration and temperature varied
  • The combined treatment appears to be associated with more complications than standard debulking surgery. The study did not directly compare the two.
  • No prospective comparison with standard debulking surgery was made, and the authors considered one not feasible because the condition is rare

Topics

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Cytoreductive Surgery, HIPEC, Peritoneal Surface Oncology, Overall Survival.

Related studies

• Multicystic peritoneal mesothelioma: outcomes and patho-biological features in a multi-institutional series treated by cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) — D. Baratti, M. Vaira, et al. (2010)
• Multicystic mesothelioma: Operative and long-term outcomes with cytoreductive surgery and hyperthermic intra peritoneal chemotherapy — E. Nizri, D. Baratti, et al. (2018)
• Benign multicystic peritoneal mesothelioma: a rare cause of intra-abdominal cystic disease — B. Campbell, D. Mehanna, et al. (2017)
• Impact of tumor angiogenesis in peritoneal mesothelioma after radical cytoreduction and hyperthermic intraperitoneal chemotherapy — T.C. Chua, P. Yao, et al. (2010)
• Institutional learning curve of cytoreductive surgery and hyperthermic intraperitoneal chemoperfusion for peritoneal malignancies — P.M. Polanco, Y. Ding, et al. (2015)
• Iterative cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent peritoneal metastases — T.C. Chua, L.E. Quinn, et al. (2013)

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