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Outcomes of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for peritoneal mesothelioma and predictors of survival

Outcomes of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for peritoneal mesothelioma and predictors of survival
Outcomes of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for peritoneal mesothelioma and predictors of survival

Background: Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) benefits selected patients with peritoneal mesothelioma. We present the outcomes of this treatment strategy in a UK peritoneal malignancy national referral centre. Methods: Observational retrospective analysis of data prospectively collected in a dedicated peritoneal malignancy database between March 1998 and January 2016. Results: Of 1586 patients treated for peritoneal malignancy, 76 (4.8%) underwent surgery for peritoneal mesothelioma. Median age was 49 years (range 21–73 years). 34 patients (45%) were female. Of the 76 patients, 39 (51%) had low grade histological subtypes (mostly multicystic mesothelioma), and 37 (49%) had diffuse malignant peritoneal mesothelioma (DMPM; mostly epithelioid mesothelioma). Complete cytoreduction was achieved in 52 patients (68%) and maximal tumour debulking (MTD) was performed in 20 patients (26%); the remaining 4 patients (5%) underwent a laparotomy with biopsy only. HIPEC was administered in 67 patients (88%). Median overall (OS) and disease-free survival (DFS) after CRS was 97.8 (80.2–115.4) and 58.8 (47.4–70.3) months, respectively. After complete cytoreduction, 100% overall survival was observed amongst patients with low-grade disease. Ki-67 proliferation index was significantly associated with survival outcomes after complete cytoreduction for DMPM and was an independent predictor of decreased survival. Conclusion: With adequate patient selection (guided by histological classification and Ki-67 proliferation index) and complete cytoreduction with HIPEC, satisfactory outcomes can be achieved in selected patients with peritoneal mesothelioma.

cytoreductive surgery, hyperthermic intraperitoneal chemotherapy, Peritoneal mesothelioma
0265-6736
1-7
Gilani, Syeda Nadia Shah
672bc297-f6e1-4985-b834-90856c1703e0
Mehta, Akash
45c8fbe9-0253-44b5-80ff-e9301c7105bf
Garcia-Fadrique, Alfonso
b8bb7848-c308-4322-800c-709609318700
Rowaiye, Babatunde
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Jenei, Veronika
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Dayal, Sanjeev
b22b44bc-1c90-405c-91d8-effee2546991
Chandrakumaran, Kandiah
f26f4bda-dfcd-439c-b449-3184b7ec7ddb
Carr, Norman
810e44dc-90d5-496c-85b6-6b2fa1c07dd7
Mohamed, Faheez
11e760f5-fd56-4f32-9264-22a2e710b365
Cecil, Tom
fff8d82e-2019-402f-a931-1c9591ffc133
Moran, Brendan
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Gilani, Syeda Nadia Shah
672bc297-f6e1-4985-b834-90856c1703e0
Mehta, Akash
45c8fbe9-0253-44b5-80ff-e9301c7105bf
Garcia-Fadrique, Alfonso
b8bb7848-c308-4322-800c-709609318700
Rowaiye, Babatunde
8983ebe0-4974-48fd-9cde-d924017c88c2
Jenei, Veronika
04d82852-7d30-458a-bc0b-f00ae6c5dd52
Dayal, Sanjeev
b22b44bc-1c90-405c-91d8-effee2546991
Chandrakumaran, Kandiah
f26f4bda-dfcd-439c-b449-3184b7ec7ddb
Carr, Norman
810e44dc-90d5-496c-85b6-6b2fa1c07dd7
Mohamed, Faheez
11e760f5-fd56-4f32-9264-22a2e710b365
Cecil, Tom
fff8d82e-2019-402f-a931-1c9591ffc133
Moran, Brendan
3465969e-87a1-4ddd-ad74-b0d1ef160f41

Gilani, Syeda Nadia Shah, Mehta, Akash, Garcia-Fadrique, Alfonso, Rowaiye, Babatunde, Jenei, Veronika, Dayal, Sanjeev, Chandrakumaran, Kandiah, Carr, Norman, Mohamed, Faheez, Cecil, Tom and Moran, Brendan (2018) Outcomes of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for peritoneal mesothelioma and predictors of survival. International Journal of Hyperthermia, 1-7. (doi:10.1080/02656736.2018.1434902).

Record type: Article

Abstract

Background: Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) benefits selected patients with peritoneal mesothelioma. We present the outcomes of this treatment strategy in a UK peritoneal malignancy national referral centre. Methods: Observational retrospective analysis of data prospectively collected in a dedicated peritoneal malignancy database between March 1998 and January 2016. Results: Of 1586 patients treated for peritoneal malignancy, 76 (4.8%) underwent surgery for peritoneal mesothelioma. Median age was 49 years (range 21–73 years). 34 patients (45%) were female. Of the 76 patients, 39 (51%) had low grade histological subtypes (mostly multicystic mesothelioma), and 37 (49%) had diffuse malignant peritoneal mesothelioma (DMPM; mostly epithelioid mesothelioma). Complete cytoreduction was achieved in 52 patients (68%) and maximal tumour debulking (MTD) was performed in 20 patients (26%); the remaining 4 patients (5%) underwent a laparotomy with biopsy only. HIPEC was administered in 67 patients (88%). Median overall (OS) and disease-free survival (DFS) after CRS was 97.8 (80.2–115.4) and 58.8 (47.4–70.3) months, respectively. After complete cytoreduction, 100% overall survival was observed amongst patients with low-grade disease. Ki-67 proliferation index was significantly associated with survival outcomes after complete cytoreduction for DMPM and was an independent predictor of decreased survival. Conclusion: With adequate patient selection (guided by histological classification and Ki-67 proliferation index) and complete cytoreduction with HIPEC, satisfactory outcomes can be achieved in selected patients with peritoneal mesothelioma.

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More information

Accepted/In Press date: 28 January 2018
e-pub ahead of print date: 12 February 2018
Keywords: cytoreductive surgery, hyperthermic intraperitoneal chemotherapy, Peritoneal mesothelioma

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Local EPrints ID: 418239
URI: https://eprints.soton.ac.uk/id/eprint/418239
ISSN: 0265-6736
PURE UUID: 5bb53cd5-6f29-4003-94a4-b2eb786f6c35

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Date deposited: 26 Feb 2018 17:30
Last modified: 13 Mar 2019 18:50

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Contributors

Author: Syeda Nadia Shah Gilani
Author: Akash Mehta
Author: Alfonso Garcia-Fadrique
Author: Babatunde Rowaiye
Author: Veronika Jenei
Author: Sanjeev Dayal
Author: Kandiah Chandrakumaran
Author: Norman Carr
Author: Faheez Mohamed
Author: Tom Cecil
Author: Brendan Moran

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