Symptoms, signs and radiologic findings in patients having reoperative surgery for malignant peritoneal mesothelioma

Our plain-English summary of Symptoms, signs and radiologic findings in patients having reoperative surgery for malignant peritoneal mesothelioma, by M.D. Llanos, P.H. Sugarbaker (European Journal of Surgical Oncology, 2017).

The study

• Authors: M.D. Llanos, P.H. Sugarbaker
• Journal: European Journal of Surgical Oncology
• Published: 2017;43(1):138-143
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: A reasonable estimate is that 50% of patients treated with cytoreductive surgery (CRS) and perioperative chemotherapy for malignant peritoneal mesothelioma will recur. Recognition of this recurrence and knowledgeable selection for additional surgical intervention is important in improving survival of patients who progress.

Material And Methods: Patients treated for malignant peritoneal mesothelioma with CRS and perioperative chemotherapy were placed in follow-up for assessment of symptoms and signs and radiologic abnormalities by CT. The data were prospectively maintained and retrospectively reviewed.

Results: From a database of 130 patients with malignant peritoneal mesothelioma, 38 patients who had 50 reoperations with disease recurrence that was histologically confirmed were studied. The median time to first recurrence was 14 months with a range of 3-102. Considering 50 reoperative events the most common symptoms or signs were abdominal pain (40%) and abdominal distention (34%). The most common radiologic finding was a tumor mass (56%). Patients with an abdominal or pelvic mass had a reduced prognosis (p = 0.006) and patients with an absence of radiologic abnormalities had an improved survival (p = 0.047).

Conclusions: In patients having reoperative surgery, symptoms, signs and radiologic abnormalities associated with recurrent (progressive) malignant peritoneal mesothelioma are abdominal pain, abdominal distention, and a tumor mass. An abdominal or pelvic mass was associated with a reduced prognosis and an absence of radiologic abnormalities with an improved prognosis.

Copyright © 2016 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

In plain English

This study reviewed prospectively collected records from one institution on 130 patients with the epithelial type of malignant peritoneal mesothelioma. They were treated from October 1994 through January 2015 with cytoreductive surgery plus heated chemotherapy inside the abdomen (HIPEC). Of these, 38 patients had 50 repeat operations at which recurrent disease was confirmed. The median time to the first repeat operation was 14 months (range 3 to 102). Across the 50 repeat operations, abdominal pain (40%) and abdominal distention (34%) were most common, and 20 operations (40%) had no recorded symptoms or signs. A tumor mass was the most common CT finding (56%). At the first repeat operation, the 7 patients with an abdominal or pelvic mass on examination had a median survival of 26 months (p = 0.006), and the 11 with no CT findings had 83 months (p = 0.047), counted from the first surgery. More symptoms or CT abnormalities did not significantly change prognosis. The authors concluded that abdominal pain and distention need investigating in follow-up, though they can have other causes. Asbestos exposure was not discussed.

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: Review of data collected prospectively in a single institution's database (case series of patients having repeat surgery for recurrence)
• Who was studied: From 130 patients with epithelial malignant peritoneal mesothelioma treated October 1994 to January 2015 at MedStar Washington Hospital Center (Washington, DC, USA), the study included 38 patients who had 50 repeat operations with histologically confirmed recurrence. Sarcomatoid, biphasic, cystic and papillary types were excluded.
• Exposure: No asbestos or other fiber exposure was studied or reported. All patients first had cytoreductive surgery with HIPEC. Some also had early postoperative intraperitoneal chemotherapy (EPIC) and bidirectional adjuvant normothermic chemotherapy (BANC). All had pemetrexed and cisplatin.
• Main results:
  • Median time to the first repeat operation, in 38 patients, was 14 months (range 3 to 102).
  • Across the 50 repeat operations, abdominal pain was recorded in 20 (40%) and abdominal distention in 17 (34%).
  • In 20 of the 50 repeat operations (40%) there were no recorded symptoms or signs.
  • A tumor mass was the most common CT finding, in 28 of 50 cases (56%).
  • At the first repeat operation, the 7 patients with an abdominal or pelvic mass (a symptom/sign) had a median survival of 26 months (p = 0.006), which the authors described as a reduced outcome.
  • At the first repeat operation, the 11 patients with no radiologic findings had a median survival of 83 months (p = 0.047).
  • The 14 patients with no symptoms or signs at the first repeat operation had a median survival of 83 months (p = 0.350, not statistically significant).
  • For all 38 patients, median survival measured from the first CRS plus HIPEC was 61.5 months, with 5-year survival of 41.6%.
  • A greater number of symptoms and signs (p = 0.283) or of radiologic abnormalities (p = 0.252) did not significantly change prognosis.
• The authors' conclusion: The authors concluded that no single symptom or sign indicated recurrence. They said abdominal pain and abdominal distention were the more common symptoms and need to be investigated during follow-up. They reported that an abdominal or pelvic mass was associated with a reduced outcome after repeat surgery and that an absence of radiologic findings was associated with improved survival.
• Limitations the authors state:
  • Abdominal pain and distention can have other causes in patients who have had major surgery and intensive chemotherapy, so many patients may have these symptoms without recurrence.
  • Treatment varied over the 21 years as regimens became more intensive and longer.
  • CT was not available for review for 2 of the 38 patients at the first repeat operation.

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: Peritoneal Mesothelioma, Cytoreductive Surgery, Chemotherapy, Prognosis.

Related studies

• Repeat Cytoreductive Surgery and HIPEC for Peritoneal Surface Malignancy and Peritoneal Carcinomatosis — J.F. Wong, G.H. Tan, et al. (2015)
• Early recurrence after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) — G.H.C. Tan, C.S. Chia, et al. (2018)
• Peritoneal metastases from small bowel cancer: Results of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in The Netherlands — T.R. van Oudheusden, V.E. Lemmens, et al. (2015)
• Iterative cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent peritoneal metastases — T.C. Chua, L.E. Quinn, et al. (2013)
• Iterative procedures combining cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for isolated peritoneal recurrence — M. Vaira, M. Robella, et al. (2014)
• A Novel Tool for Predicting Major Complications After Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy — J.M. Baumgartner, T.G. Kwong, et al. (2016)

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