Repeat cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent diffuse malignant peritoneal mesothelioma

Our plain-English summary of Repeat cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent diffuse malignant peritoneal mesothelioma, by Y. Huang, N.A. Alzahrani, W. Liauw, et al (European Journal of Surgical Oncology, 2015).

The study

• Authors: Y. Huang, N.A. Alzahrani, W. Liauw, D.L. Morris
• Journal: European Journal of Surgical Oncology
• Published: 2015;41(10):1373-8
• Cited by: 14 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Introduction: Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) has shown to improve survival outcomes for patients with diffuse malignant peritoneal mesothelioma (DMPM).

Patients And Methods: This is a retrospective study of prospectively collected data of 44 consecutive patients with DMPM who underwent CRS and HIPEC by the same surgical team at St George Hospital in Sydney, Australia. A total of 58 operations were performed. Clinical data were divided according to the number of operation and HIPEC the patient had undergone (Group 1 = initial CRS and HIPEC; Group 2 = 2nd CRS and HIPEC; Group 3 included 3rd CRS and HIPEC; Group 4 = 4th CRS and HIPEC). A significant difference was defined as p < 0.05.

Results: There were no significant differences in mortality and morbidity results among the four groups. The median survival for those who only had one operation was 22 months (95% confidence interval (CI) = 0-47.2), whereas the median survival for those who had a second operation was 62 months (95% CI = 22.9-101.1). However, such a difference did not translate into a statistical significance (p = 0.141).

Conclusion: We report an encouraging median survival of 62 months in patients who had recurrence of disease and had repeat CRS and HIPEC with similar morbidity and mortality with the initial operation. Due to the learning curve of this technique, patients with recurrent mesothelioma should be referred to specialised tertiary care centres for evaluation. Selected patients may experience prolonged survival after repeat CRS and HIPEC.

Copyright © 2015 Elsevier Ltd. All rights reserved.

In plain English

This study reviewed records of 44 consecutive patients with diffuse malignant peritoneal mesothelioma (cancer of the abdominal lining) treated at St George Hospital, Sydney, from 1999 to 2013. They had surgery to remove all visible tumour, usually followed by heated abdominal chemotherapy (HIPEC). HIPEC was left out of three emergency operations. There were 58 operations, and 10 patients had more than one. Complications and hospital deaths did not differ significantly between first and repeat operations. Three hospital deaths occurred across the 58 operations (5.2%), all after first operations. Median survival from the first operation was 22.0 months (95% confidence interval 0 to 47.2) with one operation and 62.0 months (22.9 to 101.1) with more than one. This difference was not statistically significant (p = 0.141). Of patients without a repeat operation, 23 (67.6%) had not relapsed during the study. The authors called the 62-month median among those with repeat surgery for recurrence encouraging, with complications and deaths similar to first operations. They noted the study was small, retrospective, single-centre and subject to selection bias. The article does not discuss asbestos exposure.

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 prospectively collected data from a single centre, comparing patients who had one operation with those who had repeat operations
• Who was studied: 44 consecutive patients with diffuse malignant peritoneal mesothelioma (DMPM) treated by the same surgical team at St George Hospital, Sydney, Australia, from April 1999 to December 2013. There were 58 operations in total: 44 first operations, 10 second, 3 third and 1 fourth. Ten patients had more than one operation.
• Exposure: No asbestos exposure is reported. The treatment studied was cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) with cisplatin and mitomycin, given once or repeated for recurrence. HIPEC was not performed in three procedures because it was not available during emergency surgery.
• Main results:
  • There were no statistically significant differences among the four operation groups in hospital stay, ICU stay, HDU stay, hospital mortality or complication grade.
  • Overall hospital mortality across the 58 operations was 5.2% (3 deaths). Table 2 places all 3 deaths in Group 1, the initial operations.
  • Grade III or IV complications were recorded in 31 cases (53.4%).
  • Median survival was 22.0 months (95% CI 0 to 47.2) for patients who had only one CRS with HIPEC, and 62.0 months (95% CI 22.9 to 101.1) for those who had more than one. The difference was not statistically significant (p = 0.141).
  • For the 10 patients who had reoperation, the 62-month median survival was measured from the date of the initial procedure.
  • 5-year survival was 38.9% for patients who had CRS and HIPEC once and 57.1% for patients who had it more than once.
  • Patients who had repeat CRS and HIPEC had a median survival of 56.2 months (95% CI 28.2 to 84.3) counted from the second surgery.
  • In the group without reoperation, 23 patients (67.6%) did not relapse during the study.
• The authors' conclusion: The authors reported an encouraging median survival of 62 months, counted from the initial operation, in patients with recurrence who had repeat CRS and HIPEC, with morbidity and mortality similar to the first operation. They concluded that selected patients may experience prolonged survival after repeat CRS and HIPEC. Because of the learning curve, they recommended that patients with recurrence be referred to specialised tertiary centres.
• Limitations the authors state:
  • The sample size was small.
  • It was a retrospective study at a single centre.
  • There was selection bias, because only patients judged suitable by a multidisciplinary team were offered the treatment.
  • The results came from a centre with experience of more than 800 patients, so learning-curve and volume effects should be considered.

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: Cytoreductive Surgery, HIPEC, Peritoneal Mesothelioma, Median Survival, confidence interval, Statistical Significance, Mesothelioma.

Related studies

• 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)
• Iterative cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent peritoneal metastases — T.C. Chua, L.E. Quinn, et al. (2013)
• The results of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in 1200 patients with peritoneal malignancy — B. Moran, T. Cecil, et al. (2015)
• Iterative procedures combining cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for isolated peritoneal recurrence — M. Vaira, M. Robella, et al. (2014)
• The Role of Ki-67 and Pre-cytoreduction Parameters in Selecting Diffuse Malignant Peritoneal Mesothelioma (DMPM) Patients for Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) — S. Kusamura, P.A. Torres Mesa, et al. (2016)
• Early recurrence after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) — G.H.C. Tan, C.S. Chia, et al. (2018)

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