Peritoneal cystic mesothelioma: are surgery and HIPEC optimal first-line treatments?

Our plain-English summary of Peritoneal cystic mesothelioma: are surgery and HIPEC optimal first-line treatments?, by F. Coccolini, R. Manfredi, F. Catena, et al (Onkologie, 2012).

The study

• Authors: F. Coccolini, R. Manfredi, F. Catena, C. Vallicelli, P.A. De Iaco, A. Martoni, D. Lazzareschi, L. Ansaloni
• Journal: Onkologie
• Published: 2012;35(4):200-2
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Peritoneal cystic mesothelioma (PCM) is an uncommon clinical pathology. Its high rate of recurrence following partial or total resection as well as its spontaneous onset of malignancy have been well documented in a series of case studies. The medical community has yet to define standardized treatment guidelines for PCM.

Case Reports: This study reviews the case of 2 patients admitted and treated for PCM. Recent studies have reported improved recurrence and survival rates achieved by means of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), especially when used as first-line treatments. However, whether or not the use of CRS and HIPEC is more effective than a surgical regimen of multiple debulking procedures, is still the subject of debate.

Conclusion: CRS and HIPEC as first-line treatments have lower morbidity and mortality rates than regimens of multiple back-to-back surgical procedures, and as such, the CRS/HIPEC method appears to be the more successful approach.

Copyright © 2012 S. Karger AG, Basel.

In plain English

This article was a case report describing two women treated for peritoneal cystic mesothelioma, an uncommon condition in which cysts form on the lining of the abdomen and pelvis. Both women, aged 37 and 45, had earlier had gynecological surgery for the condition. Both were admitted to the authors' surgical department for cytoreductive surgery combined with HIPEC, which is heated chemotherapy (cisplatin and adriablastin) circulated inside the abdomen. The operations lasted 700 and 570 minutes and removed all visible disease. The women spent 5 and 8 days in intensive care and left hospital 20 and 37 days after surgery. Both final diagnoses were benign multicystic peritoneal mesothelioma. Each woman was readmitted at 5 months for a recanalization procedure. Neither showed signs of recurrence at 19 and 25 months respectively. The article did not mention asbestos exposure and included no comparison group. The authors concluded that complete cytoreductive surgery and HIPEC should be used as an aggressive first-line treatment. They noted that for this rare condition, comparisons rely on indirect comparison of varied published cases, and that conclusions warrant further investigation.

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: case report of two patients
• Who was studied: Two women, aged 37 and 45, with peritoneal cystic mesothelioma (PCM), each with a previous bilateral hysteroannessiectomy, admitted to the authors' surgical department (author affiliations in Bergamo and Bologna, Italy); treatment dates not given
• Exposure: No asbestos or other exposure is reported for either patient. The article concerns treatment: complete cytoreductive surgery plus HIPEC (open technique, 41–43 °C for 90 min, cisplatin 100 mg/m2 and adriablastin 15 mg/l)
• Main results:
  • Case 1 (37-year-old woman): peritoneal cancer index 11, operative time 700 min, complete cytoreduction
  • Case 1: 5 days in intensive care; discharged 20 days after surgery
  • Case 2 (45-year-old woman): peritoneal cancer index 25, operative time 570 min, complete cytoreduction
  • Case 2: 8 days in intensive care; discharged 37 days after surgery because of social rehabilitation issues
  • Final diagnosis in both cases was benign multicystic peritoneal mesothelioma
  • Both patients were readmitted 5 months after surgery for a recanalization procedure
  • Case 1: no clinical or radiological signs of recurrence 19 months after the procedure
  • Case 2: no clinical or radiological signs of recurrence 25 months after the procedure
• The authors' conclusion: The authors concluded that complete cytoreductive surgery and HIPEC should be used as an aggressive first-line treatment for patients with peritoneal cystic mesothelioma. They stated that risk-benefit analyses and morbidity and mortality rates favor this use. The article itself presents no comparison group.
• Limitations the authors state:
  • Because the condition is rare, data can only be compared indirectly across heterogeneous published cases, and the authors said conclusions drawn from such comparisons warrant further investigation
  • There are no prospective comparative studies of CRS/HIPEC versus multiple debulking surgeries

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, HIPEC, Pathology, Cytoreductive Surgery.

Related studies

• Multicystic mesothelioma: Operative and long-term outcomes with cytoreductive surgery and hyperthermic intra peritoneal chemotherapy — E. Nizri, D. Baratti, et al. (2018)
• Peritoneal cystic mesothelioma treated with minimally invasive approach — G. Navarra, S. Occhionorelli, et al. (1996)
• Repeat Cytoreductive Surgery and HIPEC for Peritoneal Surface Malignancy and Peritoneal Carcinomatosis — J.F. Wong, G.H. Tan, et al. (2015)
• Current practice in cytoreductive surgery and HIPEC for metastatic peritoneal disease: Spanish multicentric survey — R. Morales-Soriano, N. Esteve-Pérez, 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)
• Peritoneal carcinomatosis: intraoperative parameters in open (coliseum) versus closed abdomen HIPEC — E. Halkia, A. Tsochrinis, et al. (2015)

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