Multicystic mesothelioma: Operative and long-term outcomes with cytoreductive surgery and hyperthermic intra peritoneal chemotherapy

Our plain-English summary of Multicystic mesothelioma: Operative and long-term outcomes with cytoreductive surgery and hyperthermic intra peritoneal chemotherapy, by E. Nizri, D. Baratti, M. Guaglio, et al (European Journal of Surgical Oncology, 2018).

The study

• Authors: E. Nizri, D. Baratti, M. Guaglio, S. Sinukumar, A. Cabras, S. Kusamura, M. Deraco
• Journal: European Journal of Surgical Oncology
• Published: 2018;44(7):1100-1104
• Cited by: 31 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Multicystic peritoneal mesothelioma (MCPM) is an extremely rare disease with 40-50% rate of recurrence after surgical debulking. Due to the recurrent nature of the disease, the option of cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC) was offered for this condition. In the present study we aimed to describe the outcomes of this strategy in a single center cohort.

Methods: We retrospectively reviewed a prospectively collected database of all patients with MCPM that underwent the combined procedure in our center. Clinical presentation, operative procedures and outcomes were reviewed.

Results: Between August 1997 and October 2017, 19 patients with MCPM underwent 20 cytoreduction and HIPEC procedures in our center. The majority of the patients were females (n = 17, 89%), and mean age was 42, as reported in other series. Disease extent, as measured by mean peritoneal carcinomatosis index (PCI) was 15.5 ± 9.9 and total number of procedures performed 6.7 ± 2.6. Major complications occurred in 3 (15%) patients, with no perioperative mortality. After a median of follow-up of 69 months (range 4-220) all patients were alive and 4 patients had recurrence (21%). Patients with high PCI (defined by median PCI) had shorter recurrence free survival (RFS) than patient with low PCI (mean RFS = 106.4 ± 6.6 for high PCI vs. 125.6 ± 34.1 for low PCI, p = 0.03).

Conclusion: Cytoreduction and HIPEC offer low recurrence rate and prolonged mean RFS for patients with MCPM. The combined procedure can be offered with acceptable morbidity in specialized centers.

Copyright © 2018 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

In plain English

This was a retrospective review of a prospectively kept database at a specialized peritoneal cancer unit in Milan, Italy. It covered 19 patients with multicystic peritoneal mesothelioma (MCPM), a rare tumor of the abdominal lining. Together they had 20 operations that combined cytoreductive surgery (removal of visible disease and of the abdominal lining) with heated chemotherapy, mainly cisplatin and doxorubicin, bathed inside the abdomen during the operation (HIPEC). Most patients were women, with a mean age of about 42. The article did not report on asbestos exposure in these patients. Major complications occurred after 3 of the 20 procedures (15%), and no patient died around the time of surgery. Over a median follow-up of 69 months, no deaths from the disease were reported. Four patients (21%) had a recurrence. The rate of staying free of recurrence was 84% at 5 years and 79% at 10 years. Patients with more extensive disease at surgery had shorter recurrence-free survival (p=0.03). The authors concluded that the combined treatment offers a low recurrence rate and relatively low complication rate. They noted that the number of patients was small and that complication rates from a specialized unit cannot be generalized.

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 review of a prospectively collected single-center database (case series)
• Who was studied: 19 patients with pathologically proven multicystic peritoneal mesothelioma who had 20 procedures at the Peritoneal Surface Malignancies Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy. The Results section says August 1995 to October 2017; the abstract says August 1997. Table 1 lists 16 female and 3 male patients, with a mean age of 41.95.
• Exposure: Treatment studied, not an asbestos exposure: cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy, using cisplatin and doxorubicin in most patients. Asbestos exposure of the patients was not reported.
• Main results:
  • Major complications (grade 3 to 5) occurred after 3 of 20 procedures (15%); there were no perioperative deaths
  • Median follow-up was 69 months (range 4 to 220); no death due to the disease was reported
  • 4 patients (21%) had recurrence: two after about 20 months and two later, at 48 to 83 months
  • Recurrence-free survival rates for the whole cohort were 84% at 5 years and 79% at 10 years; mean recurrence-free survival was 159.4 plus or minus 27 months, and the median was not reached
  • Patients with a peritoneal cancer index above the median (11) had a shorter mean recurrence-free survival (106.4 plus or minus 6.6 months) than patients with a low index (125.6 plus or minus 34.1 months), p=0.03
  • In the 3 patients whose uterus and ovaries were preserved, mean recurrence-free survival was 52.8 plus or minus 30.8 months, versus 189.3 plus or minus 20.3 in those who had hysterectomy and removal of ovaries (p=0.06, not statistically significant)
  • No visible residual disease (CCR-0) was achieved in 17 patients (89.5%); CCR-1 in the remaining 3
  • The authors found no association with pelvic inflammatory disease or endometriosis in this group
• The authors' conclusion: The authors concluded that cytoreductive surgery with HIPEC offers a low recurrence rate and relatively low morbidity for MCPM. They proposed counseling patients on this option, preferably in a specialized center.
• Limitations the authors state:
  • The number of patients is small, because the disease is rare
  • The complication rate from a specialized unit cannot be generalized to other settings
  • The small numbers do not support the effectiveness of the complete parietal peritonectomy approach in MCPM

Topics

Medical terms in this study, explained in our Lexicon: Multicystic Mesothelioma (MCM), Cytoreductive Surgery, Chemotherapy, Peritoneal Mesothelioma, HIPEC.

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)
• Long term survival and perioperative propensity score matched outcomes of diaphragmatic resections compared to stripping in cytoreductive surgery + intra-peritoneal chemotherapy — B. Singh, G. Singh, et al. (2020)
• Long-term Survival and Propensity Score Matched Outcomes of Bilateral vs. Unilateral Diaphragm Interventions in Cytoreductive Surgery plus Intra-peritoneal Chemotherapy — B. Singh, G. Singh, et al. (2018)
• Outcomes of repeat cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for the treatment of peritoneal surface malignancy — K.I. Votanopoulos, C. Ihemelandu, et al. (2012)
• Is Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy Justified for Biphasic Variants of Peritoneal Mesothelioma? Outcomes from the Peritoneal Surface Oncology Group International Registry — K.I. Votanopoulos, P. Sugarbaker, et al. (2018)
• Postoperative outcomes of laparoscopic vs open cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy for treatment of peritoneal surface malignancies — G. Passot, N. Bakrin, et al. (2014)

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