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Peritoneal Mesothelioma Treated by Cytoreductive Surgery and Intraperitoneal Hyperthermic Chemotherapy: Results of a Prospective Study

¹ Department of General Surgery, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
² Department of Emergency Surgery, Hôpital Edouard Herriot, Lyon, France
³ Equipe Accueil 3738, Facultéde Médecine Lyon-Sud, Oullins, France
⁴ Department of General Surgery, Newcastle upon Tyne, United Kingdom
⁵ Department of Anesthesiology, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France
⁶ Department of Pathology, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France
⁷ Department of Surgical Oncology, Centre Hospitalier Lyon-Sud, 69495 Pierre-Beénite Cédex, France

Correspondence: Address correspondence and reprint requests to: O. Glehen, MD, PhD; E-mail: olivier.glehen{at}chu-lyon.fr.

Background: Peritoneal mesothelioma is a rare disease with few therapeutic options. Recently, the combination of cytoreductive surgery with intraperitoneal hyperthermic chemotherapy (HIPEC) has shown promising results.

Methods: Fifteen patients with peritoneal mesothelioma who were treated by cytoreductive surgery and HIPEC between 1989 and 2004 were identified from a prospective database. HIPEC was performed with cisplatin and mitomycin C for 90 minutes by using the closed-abdomen technique.

Results: All patients but one (multicystic) had malignant disease of the following pathologic types: 12 epithelial and 2 biphasic. After surgical resection, 11 patients were considered to have a CC-0 or CC-1 resection (macroscopic complete resection or diameter of residual nodules <2.5 mm). No postoperative death occurred, and six postoperative complications were recorded. All but one patient had resolution of ascites. The overall median survival for the 14 patients with malignant mesothelioma was 35.6 months. The median survival was 37.8 months for patients treated with a CC-0 or CC-1 resection, whereas it was 6.5 months for those treated with a CC-2 or CC-3 resection (diameter of residual nodules >2.5 mm; P < .001). In a univariate analysis, the only other significant prognostic factor was the carcinomatosis extent (P = .02).

Conclusions: A therapeutic strategy combining cytoreductive surgery with HIPEC seems to provide an adequate and efficient locoregional treatment for peritoneal mesothelioma. It is associated with acceptable morbidity when performed by an experienced surgical team. The completeness of cytoreduction is the major determinant of survival.

Key Words: Peritoneal mesothelioma • Cytoreductive surgery • Intraperitoneal chemotherapy • Hyperthermia • Peritoneal carcinomatosis • Survival

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