Outcomes of multicystic peritoneal mesothelioma treatment with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

Our plain-English summary of Outcomes of multicystic peritoneal mesothelioma treatment with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, by A. Zahid, L. Clarke, N. Carr, et al (BJS Open, 2021).

The study

• Authors: A. Zahid, L. Clarke, N. Carr, K. Chandrakumaran, A. Tzivanakis, S. Dayal, F. Mohamed, T. Cecil, B.J. Moran
• Journal: BJS Open
• Published: 2021;5(2)
• Cited by: 11 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Multicystic peritoneal mesothelioma (MCPM) is a rare neoplasm, generally considered a borderline malignancy, best treated by cytoreductive surgery (CRS) to remove macroscopic disease, combined with hyperthermic intraperitoneal chemotherapy (HIPEC). Owing to its rarity, little has been published on clinical presentation, clinical behaviour over time, or an optimal treatment approach.

Methods: A prospectively developed peritoneal malignancy database was interrogated for the years 2001-2018. Details on all patients with MCPM as a definitive diagnosis after CRS and HIPEC were analysed, including previous interventions, mode of presentation, surgical treatment, postoperative outcomes, and late follow-up information from abdominal CT and tumour markers.

Results: Some 40 patients with MCPM underwent CRS and HIPEC between 2001 and 2018. Of these, 32 presented with abdominal pain, distension or bloating, six patients presented with recurrence following previous surgery at the referring hospitals, and two had coincidental diagnoses during a surgical procedure. CRS involved peritonectomy in all 40 patients. Bowel resection was required in 18 patients, and seven had a temporary stoma. Thirty-eight patients were considered to have undergone a complete macroscopic tumour removal (completeness of cytoreduction CC0), and two had residual tumour nodules less than 2.5 mm in size, classified as CC1. Median duration of follow-up was 65 (range 48-79) months. There were no deaths during follow-up. The Kaplan-Meier-predicted recurrence-free interval was 115.4 months.

Conclusion: MCPM is a rare peritoneal neoplasm with a heterogeneous pattern of presentation. CRS and HIPEC is an effective management option for this group of patients, with favourable long-term survival.

© The Author(s) 2020. Published by Oxford University Press on behalf of BJS Society Ltd.

In plain English

This study described how the Peritoneal Malignancy Institute in Basingstoke, UK, treated multicystic peritoneal mesothelioma (MCPM), a rare tumour of the abdominal lining. Between 2001 and 2018, 40 patients (26 women; median age 41.5 years) had cytoreductive surgery, which removes visible tumour, followed by heated chemotherapy delivered into the abdomen (HIPEC). Of the 40, 31 came with abdominal swelling, bloating or pain. Visible tumour was fully removed in 38 patients. Over a median follow-up of 65.0 months (95 per cent confidence interval 48.4 to 79.0) there were no deaths. The estimated average recurrence-free time was 115.4 months (95 per cent confidence interval 93.8 to 137.0); the median was not reached. Men had a shorter disease-free interval than women (hazard ratio 6.0, 95 per cent confidence interval 1.43 to 25.11). Serious complications occurred in 2 of 40 patients. The study did not look at asbestos. Its introduction, citing earlier reports, says unlike other mesotheliomas, MCPM has no reported link to asbestos exposure. The authors concluded that their results support this treatment as the preferred approach for selected patients at specialist units.

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: Single-centre case series: a retrospective analysis of a prospectively developed registry of surgical patients with peritoneal malignancy
• Who was studied: 40 patients with histologically proven multicystic peritoneal mesothelioma who had CRS and HIPEC at the Peritoneal Malignancy Institute, Basingstoke Hospital, UK, 2001 to 2018. They came from 102 patients with peritoneal mesothelioma among 2245 who had surgery for peritoneal malignancy. 26 of the 40 were women; median age 41.5 (range 21 to 69) years.
• Exposure: No asbestos or other environmental exposure was studied. The 'exposure' was the treatment: cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC), using doxorubicin and cisplatin in 25 patients and mitomycin C in 15. The introduction, citing other studies, states there is no reported link between MCPM and asbestos exposure.
• Main results:
  • Presentation: 31 of the 40 patients had abdominal distension, bloating and/or pain. Six had disease progression after surgery at referring hospitals. Two were diagnosed by chance during another operation.
  • 38 of 40 patients had complete removal of visible tumour (CC0). The other 2 had residual nodules up to 2.5 mm (CC1).
  • Seven patients had a temporary ileostomy. All were reversed a median of 7 (range 3 to 11) months later.
  • Median follow-up was 65.0 (95 per cent c.i. 48.4 to 79.0) months. No patient died during follow-up, and 25 patients had been alive more than 5 years at census.
  • For all 40 patients, the mean Kaplan–Meier-predicted recurrence-free interval was 115.4 (95 per cent c.i. 93.8 to 137.0) months. The median was not reached.
  • Mean predicted disease-free interval was 132.6 (95 per cent c.i. 112.2 to 153.0) months for women and 51.1 (30.0 to 72.1) months for men.
  • In Cox regression, being male was the only variable linked to a significantly shorter disease-free interval: hazard ratio 6.0 (95 per cent c.i. 1.43 to 25.11; P equals 0.018) versus women. Other variables did not affect the disease-free interval.
  • 35 patients had minor (Clavien–Dindo grade I or II) complications. Significant (grade III to IV) complications occurred in 2 of 40 patients (5 per cent).
  • Seven patients had a raised CA125 level before surgery; two of these seven developed recurrence.
• The authors' conclusion: The authors concluded that the high risk of recurrence and the potential for malignant transformation warrant considering surgery for MCPM. In their view, the safety and efficacy of CRS and HIPEC in selected patients at a specialist unit support its continued use as the preferred approach. In the discussion they also stated that the treatment gave a 5-year progression-free survival rate of more than 80 per cent and a 10-year overall survival rate approaching 100 per cent in this series.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma, Peritoneal mesothelioma.

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Cytoreductive Surgery, HIPEC, Neoplasm, Bowel Resection.

Related studies

• Laparoscopic cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for limited peritoneal metastasis. The PSOGI international collaborative registry — A. Arjona-Sanchez, O. Aziz, et al. (2021)
• Outcomes of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for peritoneal mesothelioma and predictors of survival — S.N.S. Gilani, A. Mehta, et al. (2018)
• Unresectable peritoneal metastasis treated by pressurized intraperitoneal aerosol chemotherapy (PIPAC) leading to cytoreductive surgery and hyperthermic intraperitoneal chemotherapy — M. Alyami, F. Mercier, et al. (2021)
• The role of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the treatment of peritoneal carcinomatosis: a systematic review including evidence from Japan — T. Kitai (2021)
• The results of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in 1200 patients with peritoneal malignancy — B. Moran, T. Cecil, et al. (2015)
• Influence of the effectiveness of sarcopenia on postoperative major complications after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients with peritoneal surface malignancy: a retrospective cohort study — N. Havan, S. Gülmez, et al. (2025)

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