Ten-year single-center experience with treatment of primary diffuse malignant peritoneal mesothelioma (DMPM) by cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC)

• Published in: Langenbeck's archives of surgery Vol. 407; no. 7; pp. 3057 - 3067
• Main Authors: Acs, Miklos, Gerken, Michael, Gajic, Ivana, Mayr, Max, Zustin, Jozef, Piso, Pompiliu
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-11-2022
• Subjects: Abdominal Surgery; Cardiac Surgery; General Surgery; Medicine; Medicine & Public Health; Original Article; Thoracic Surgery; Traumatic Surgery; Vascular Surgery; HIPEC; Malignant peritoneal mesothelioma; Cytoreductive surgery
• ISSN: 1435-2451; 1435-2451
• DOI: 10.1007/s00423-022-02594-6

Purpose
This single-center study evaluated cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) for diffuse malignant peritoneal mesothelioma (DMPM).
Methods
Prospectively collected data from a single institution data registry was retrospectively investigated. Eighty-four patients with primary malignant peritoneal mesothelioma underwent CRS and HIPEC with cisplatin and doxorubicin either for 60 min or 90 min of duration from 2011 to 2021. The primary endpoint was overall survival. The secondary endpoint was the evaluation of prognostic factors for overall survival. The tertiary endpoint was to assess the effect of neoadjuvant chemotherapy on survival.
Results
The median follow-up was 5.0 years (95%-CI 4.6–5.5). The median age was 59.2 years (IQR: 47–66). Eighty-two patients (97.6%) had epithelioid tumors. The median peritoneal cancer index was 18.0 (IQR: 13–27). Sixty-six patients (78.6%) had complete or near-complete cytoreduction (CCR 0 or CCR 1). Seventy patients (83.3%) received HIPEC for 60 min and 14 patients (16.7%) received it for 90 min. Twenty-two patients (26.2%) had grade 3 to 4 complications. Acute kidney injury (AKI) stage I–III occurred in 30 (35.7%) patients. Three patients (3.6%) died perioperatively. The overall median survival was 38.4 months (95%-CI 23.6–54.3), and the 5-year survival rate was 42%. Survival was independently associated with age, female gender, and thrombocytosis. Preoperative chemotherapy did not emerge as an adverse prognostic factor.
Conclusion
In well-selected patients with DMPM, prolonged survival is achievable with CRS and HIPEC in specialized centers.