Overall survival of pseudomyxoma peritonei and peritoneal mesothelioma patients after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy can be predicted by computed tomography quantified sarcopenia

Our plain-English summary of Overall survival of pseudomyxoma peritonei and peritoneal mesothelioma patients after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy can be predicted by computed tomography quantified sarcopenia, by A. Galan, P. Rousset, F. Mercier, et al (European Journal of Surgical Oncology, 2018).

The study

• Authors: A. Galan, P. Rousset, F. Mercier, V. Képénékian, P.J. Valette, O. Glehen, G. Passot
• Journal: European Journal of Surgical Oncology
• Published: 2018;44(11):1818-1823
• Cited by: 16 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Malnutrition is associated with increased postoperative morbidity in abdominal surgery. This study aimed to determine if sarcopenia and/or abdominal fat composition could predict postoperative outcomes for patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) for pseudomyxoma peritonei (PMP) and peritoneal mesothelioma (PM).

Methods: All patients who underwent a complete CRS-HIPEC for PMP and PM, between January 2009 and September 2017, were retrospectively studied. Preoperative computed tomography (CT) was used to measure the cross-sectional surface of skeletal muscle mass and adipose tissue (visceral and subcutaneous), at the level of the third lumbar vertebrae, to assess for sarcopenia and abdominal fat composition.

Results: Among 115 patients, 82 were treated for PMP and 33 for PM. 64 patients (55.7%) were sarcopenic on the preoperative imagery. Major postoperative complications occurred in 63 patients (54.8%), without observable difference between sarcopenic and non-sarcopenic patients (56.2% vs. 52.9%; p = 0.723). The median overall survival (OS) was 73.3 for the patients with a normal muscle mass and 57.2 months for the sarcopenic patients (p = 0.05).

Conclusion: CT measured sarcopenia is an independent predictive factor for overall survival in patients treated for PMP and PM with CRS-HIPEC, but cannot predict postoperative morbidity.

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

In plain English

This retrospective study from Lyon Sud hospital, France, looked at 115 patients who had complete cytoreductive surgery with heated abdominal chemotherapy (CRS-HIPEC) between January 2009 and September 2017. Of these, 82 were treated for pseudomyxoma peritonei and 33 for peritoneal mesothelioma. The study did not look at asbestos exposure. A radiologist measured muscle on preoperative CT scans at the third lumbar vertebra. By that measure, 64 patients (55.7%) had low muscle mass, called sarcopenia. Median follow-up was 18.1 months. Median overall survival was 73.3 months for patients without sarcopenia and 57.2 months for those with it (p = 0.05). In the peritoneal mesothelioma patients alone, the difference (57.7 versus 39.2 months) was not statistically significant. Major complications occurred in 63 patients (54.8%): 56.2% of sarcopenic versus 52.9% of non-sarcopenic patients, not a statistically significant difference. Within 90 days of surgery, no non-sarcopenic patient died, compared with 4 (6.2%) sarcopenic patients; this difference was not statistically significant. The authors concluded that sarcopenia was an independent predictor of overall survival. They noted limits including the retrospective, single-center design and likely exclusion of sarcopenic patients from surgery.

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 study of a prospectively kept database at a single hospital (Lyon Sud hospital, France), covering January 2009 to September 2017
• Who was studied: 115 patients who had complete CRS-HIPEC (out of 194 treated in the period): 82 treated for pseudomyxoma peritonei (PMP) and 33 for peritoneal mesothelioma (PM)
• Exposure: The factor studied was sarcopenia (low skeletal muscle mass), measured on preoperative CT at the third lumbar vertebra. It was defined as a skeletal muscle index of 39 cm2/m2 or less for women and 55 cm2/m2 for men. Asbestos exposure was not studied; asbestos appears only in the introduction, citing other work.
• Main results:
  • 64 of the 115 patients (55.7%) were sarcopenic on preoperative imaging
  • The sarcopenic group was older (median age 63.2 vs 50.7 years; p = 0.002) and had lower BMI (22.3 vs 24.2; p = 0.003) than the non-sarcopenic group
  • Median follow-up for all patients was 18.1 months (range 0 to 82)
  • All patients: median overall survival was 73.3 months in the non-sarcopenic group versus 57.2 months in the sarcopenic group (p = 0.05)
  • All patients: median progression-free survival was 55.5 months in the non-sarcopenic group versus 48.4 months in the sarcopenic group (p = 0.0635); the authors reported no impact on progression-free survival
  • Pseudomyxoma peritonei patients only: median overall survival was 72.3 months non-sarcopenic versus 57.2 months sarcopenic (p = 0.045)
  • Peritoneal mesothelioma patients only: median overall survival was 57.7 months non-sarcopenic versus 39.2 months sarcopenic (p = 0.669), which was not statistically significant
  • Major postoperative complications occurred in 63 of 115 patients (54.8%): 56.2% of sarcopenic versus 52.9% of non-sarcopenic patients (p = 0.723), which was not statistically significant
  • Deaths within 90 days of surgery: none in the non-sarcopenic group versus 4 (6.2%) in the sarcopenic group (p = 0.069), which was not statistically significant. Table 1 labels these as deaths within 90 days.
  • The death figures in Table 1 are limited to deaths within 90 days of surgery (4 of 115 patients overall, 3.5%)
  • Failure to rescue (death after a major complication): no events in the non-sarcopenic group versus 11.1% in the sarcopenic group (p = 0.073), which was not statistically significant
• The authors' conclusion: The authors concluded that preoperative sarcopenia is an independent predictor of overall survival after CRS and HIPEC for peritoneal mesothelioma or pseudomyxoma peritonei. They added that it seems to be associated with a higher risk of death when a major complication occurs.
• Limitations the authors state:
  • The study was retrospective
  • Selecting patients at the preoperative consultation likely excluded more sarcopenic patients, because they were more likely to be judged unfit for surgery
  • All patients received immunonutrition in the week before surgery, with unknown effect on nutritional and muscle measurements
  • CT measurements were sometimes difficult because of abundant ascites (fluid in the abdomen)
  • Only muscle mass was measured, not muscle function
  • The study population was too small to reach statistical significance for the failure-to-rescue rate
  • As a single-center study, the results may not be generalizable
  • Only patients who had complete CRS-HIPEC were included

Topics

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

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

Related studies

• The results of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in 1200 patients with peritoneal malignancy — B. Moran, T. Cecil, et al. (2015)
• Iterative cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent or progressive diffuse malignant peritoneal mesothelioma: clinicopathologic characteristics and survival outcome — C. Ihemelandu, L. Bijelic, et al. (2015)
• A proposal of Brazilian Society of Surgical Oncology (BSSO/SBCO) for standardizing cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) procedures in Brazil: pseudomixoma peritonei, appendiceal tumors and malignant peritoneal mesothelioma — T.P. Batista, B.J.Q. Sarmento, et al. (2017)
• Cytoreductive Surgery and Intraperitoneal Hyperthermic Chemotherapy (HIPEC) by Minimally Invasive Approach, an Initial Experience — A. Arjona-Sanchez, S. Rufian-Peña, et al. (2018)
• Laparoscopic cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for limited peritoneal metastasis. The PSOGI international collaborative registry — A. Arjona-Sanchez, O. Aziz, et al. (2021)
• 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)

Browse more research in European Journal of Surgical Oncology, or return to medical research.