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Survival Outcomes for Malignant Peritoneal Mesothelioma at Academic Versus Community Hospitals

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Malignant peritoneal mesothelioma is a rare disease with poor outcomes. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy is the cornerstone of therapy. We aim to compare outcomes of malignant peritoneal mesothelioma treated at academic versus community hospitals.

Methods

This was a retrospective cohort study using the National Cancer Database to identify patients with malignant peritoneal mesothelioma from 2004 to 2016. Patients were divided according to treating facility type: academic or community. Outcomes were assessed using log-rank tests, Cox proportional-hazard modeling, and Kaplan-Meier survival statistics.

Results

In total, 2682 patients with malignant peritoneal mesothelioma were identified. A total of 1272 (47.4%) were treated at an academic facility and 1410 (52.6%) were treated at a community facility. Five hundred forty-six (42.9%) of patients at academic facilities underwent debulking or radical surgery compared to 286 (20.2%) at community facilities. Three hundred sixty-six (28.8%) of patients at academic facilities received chemotherapy on the same day as surgery compared to 147 (10.4%) of patients at community facilities. Unadjusted 5-year survival was 29.7% (95% CI 26.7–32.7) for academic centers compared to 18.3% (95% CI 16.0–20.7) for community centers. In multivariable analysis, community facility was an independent predictor of increased risk of death (HR: 1.19, 95% CI 1.08–1.32, p = 0.001).

Conclusions

We demonstrate better survival outcomes for malignant peritoneal mesothelioma treated at academic compared to community facilities. Patients at academic centers underwent surgery and received chemotherapy on the same day as surgery more frequently than those at community centers, suggesting that malignant peritoneal mesothelioma patients may be better served at experienced academic centers.

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References

  1. Miura JT, Johnston FM, Gamblin TC, Turaga KK. Current Trends in the Management of Malignant Peritoneal Mesothelioma. Annals of Surgical Oncology. 2014;21(12):3947-53. doi:https://doi.org/10.1245/s10434-014-3803-6.

    Article  PubMed  Google Scholar 

  2. Bridda A, Padoan I, Mencarelli R, Frego M. Peritoneal mesothelioma: a review. MedGenMed. 2007;9(2):32.

    PubMed  PubMed Central  Google Scholar 

  3. Kim J, Bhagwandin S, Labow DM. Malignant peritoneal mesothelioma: a review. Ann Transl Med. 2017;5(11):236. doi:https://doi.org/10.21037/atm.2017.03.96.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Turaga KK, Deraco M, Alexander HR. Current management strategies for peritoneal mesothelioma. International Journal of Hyperthermia. 2017;33(5):579-81. doi:https://doi.org/10.1080/02656736.2017.1320591.

    Article  PubMed  Google Scholar 

  5. Sugarbaker PH, Yan H, Grazi RV, Shmookler BM. Early localized peritoneal mesothelioma as an incidental finding at laparoscopy. Report of a case and implications regarding natural history of the disease. Cancer. 2000;89(6):1279-84. https://doi.org/10.1002/1097-0142(20000915)89:6<1279::aid-cncr12>3.0.co;2-8.

    Article  CAS  PubMed  Google Scholar 

  6. de Pangher Manzini V. Malignant peritoneal mesothelioma. Tumori. 2005;91(1):1-5.

    Article  Google Scholar 

  7. Salemis NS, Tsiambas E, Gourgiotis S, Mela A, Karameris A, Tsohataridis E. Peritoneal mesothelioma presenting as an acute surgical abdomen due to jejunal perforation. J Dig Dis. 2007;8(4):216-21. doi:https://doi.org/10.1111/j.1751-2980.2007.00309.x.

    Article  PubMed  Google Scholar 

  8. Sethna K, Sugarbaker PH. Localized visceral invasion of peritoneal mesothelioma causing intestinal obstruction: a new clinical presentation. Hepatogastroenterology. 2005;52(64):1087-9.

    PubMed  Google Scholar 

  9. Mohamed F, Sugarbaker PH. Peritoneal mesothelioma. Curr Treat Options Oncol. 2002;3(5):375-86. doi:https://doi.org/10.1007/s11864-002-0003-6.

    Article  PubMed  Google Scholar 

  10. Magge D, Zenati MS, Austin F, Mavanur A, Sathaiah M, Ramalingam L et al. Malignant Peritoneal Mesothelioma: Prognostic Factors and Oncologic Outcome Analysis. Annals of Surgical Oncology. 2014;21(4):1159-65. doi:https://doi.org/10.1245/s10434-013-3358-y.

    Article  PubMed  Google Scholar 

  11. Yan TD, Welch L, Black D, Sugarbaker PH. A systematic review on the efficacy of cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for diffuse malignancy peritoneal mesothelioma. Ann Oncol. 2007;18(5):827-34. doi:https://doi.org/10.1093/annonc/mdl428.

    Article  CAS  PubMed  Google Scholar 

  12. NCCN. NCCN Guidelines for Treatment of Cancer By Site. In: NCCN Guidelines. National Comprehensive Cancer Network (NCCN), National Comprehensive Cancer Network (NCCN). 2019. https://www.nccn.org/professionals/physician_gls/default.aspx#ovarian. Accessed November 30 2020.

  13. ACS. Malignant Mesothelioma Stages. American Cancer Society. 2018. https://www.cancer.org/cancer/malignant-mesothelioma/detection-diagnosis-staging/staging.html#references. Accessed November 23 2020.

  14. Yan TD, Deraco M, Elias D, Glehen O, Levine EA, Moran BJ et al. A novel tumor-node-metastasis (TNM) staging system of diffuse malignant peritoneal mesothelioma using outcome analysis of a multi-institutional database*. Cancer. 2011;117(9):1855-63. doi:https://doi.org/10.1002/cncr.25640.

    Article  PubMed  Google Scholar 

  15. Chicago Consensus Working G. The Chicago Consensus on Peritoneal Surface Malignancies: Management of Peritoneal Mesothelioma. Ann Surg Oncol. 2020;27(6):1774-9. doi:https://doi.org/10.1245/s10434-020-08324-w.

    Article  Google Scholar 

  16. ACS. National Cancer Database. American College of Surgeons. https://www.facs.org/quality-programs/cancer/ncdb. Accessed November 17 2020.

  17. Yan TD, Brun EA, Cerruto CA, Haveric N, Chang D, Sugarbaker PH. Prognostic Indicators for Patients Undergoing Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy for Diffuse Malignant Peritoneal Mesothelioma†. Annals of Surgical Oncology. 2007;14(1):41-9. doi:https://doi.org/10.1245/s10434-006-9169-7.

    Article  PubMed  Google Scholar 

  18. Bijelic L, Darcy K, Stodghill J, Tian C, Cannon T. Predictors and Outcomes of Surgery in Peritoneal Mesothelioma: an Analysis of 2000 Patients from the National Cancer Database. Ann Surg Oncol. 2020;27(8):2974-82. doi:https://doi.org/10.1245/s10434-019-08138-5.

    Article  PubMed  Google Scholar 

  19. Rajeev R, Klooster B, Turaga KK. Impact of surgical volume of centers on post-operative outcomes from cytoreductive surgery and hyperthermic intra-peritoneal chemoperfusion. Journal of Gastrointestinal Oncology. 2015;7(1):122-8.

    Google Scholar 

  20. Kerscher AG, Mallalieu J, Pitroff A, Kerscher F, Esquivel J. Morbidity and mortality of 109 consecutive cytoreductive procedures with hyperthermic intraperitoneal chemotherapy (HIPEC) performed at a community hospital. World J Surg. 2010;34(1):62-9. doi:https://doi.org/10.1007/s00268-009-0281-2.

    Article  PubMed  Google Scholar 

  21. Goslin B, Sevak S, Siripong A, Onesti J, Wright GP, Melnik M et al. Outcomes of cytoreduction with hyperthermic intraperitoneal chemotherapy: our experience at a midwest community hospital. Am J Surg. 2012;203(3):383-6; discussion 7. doi:https://doi.org/10.1016/j.amjsurg.2011.09.009.

    Article  PubMed  Google Scholar 

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All authors had substantial contributions to the conception or design of the work; or to the acquisition, analysis, or interpretation of the work; to drafting or revising of the work; made final approval; and agreed to be accountable for all aspects of the work.

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Correspondence to Vanessa M. Welten MD MPH.

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This work was presented as an ePoster presentation during the Society of Surgical Oncology (SSO) 2021 International Conference on Surgical Cancer Care, held virtually March 18–19, 2021.

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Welten, V.M., Fields, A.C., Malizia, R.A. et al. Survival Outcomes for Malignant Peritoneal Mesothelioma at Academic Versus Community Hospitals. J Gastrointest Surg 26, 161–170 (2022). https://doi.org/10.1007/s11605-021-05084-0

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