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Is Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy Justified for Biphasic Variants of Peritoneal Mesothelioma? Outcomes from the Peritoneal Surface Oncology Group International Registry

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) has dramatically improved the survival of patients with epithelioid peritoneal mesothelioma. It is unknown if CRS/HIPEC is indicated for the more aggressive biphasic mesothelioma variant.

Methods

A retrospective analysis of the Peritoneal Surface Oncology Group International (PSOGI) registry including data from 33 centers was performed. Survival was reviewed based on mesothelioma type, completion of cytoreduction, and volume of disease.

Results

Overall, 484 of 1165 (41.5%) CRS/HIPEC procedures with complete CC0 and CC1 cytoreductions were analyzed; 450 (93%) procedures were performed for epithelioid mesotheliomas, while 34 (7%) were performed for biphasic mesotheliomas. For patients with CC0 resection, 5-year survival was 64.5 and 50.2% (median 7.8 and 6.8 years; p = 0.015) for epithelioid and biphasic mesotheliomas, respectively, while inclusion of CC1 resections in the analysis resulted in inferior 5-year survival of 62.9% and 41.6% (median 7.8 and 2.8 years; p = 0.0012), respectively. Incomplete CC2 resections for biphasic primaries resulted in a median survival of 4.3 months. Univariate analysis of the biphasic cohort indicated Peritoneal Cancer Index (PCI; p = 0.015), CC status of resection (p < 0.0001), and Ki67 (p = 0.04) as predictors of survival. Systemic chemotherapy before (p = 0.55) or after (p = 0.7) CRS/HIPEC did not influence survival. In multivariate analysis, only PCI (p = 0.03) and CC (p = 0.04) remained significant.

Conclusions

Long-term survival is achievable in patients with low-volume biphasic mesothelioma after complete macroscopic cytoreduction. Biphasic peritoneal mesotheliomas should not be considered as an absolute contraindication for CRS/HIPEC if there is low-volume disease and if complete cytoreduction can be achieved.

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Disclosures

Konstantinos I. Votanopoulos, Paul Sugarbaker, Marcello Deraco, David Morris, Olivier Glehen, Dominique Elias, Michele De Simone, Manuela Robella, Bruno Heyd, Shigeki Kusamura, Dario Baratti, Konstantinos Chouliaras, Greg Russell, Perry Shen, and Edward A. Levine have no disclosures to declare.

Funding

This work was supported by Wake Forest University Biostatistics shared resource NCI CCSG P30CA012197.

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Authors and Affiliations

  1. Surgical Oncology Service, Department of General Surgery, Wake Forest Baptist Health, Winston-Salem, NC, USA

    Konstantinos I. Votanopoulos MD, PhD, FACS, Paul Sugarbaker MD, Marcello Deraco MD, David Morris MD, Olivier Glehen MD, Dominique Elias MD, Michele De Simone MD, Manuela Robella MD, Bruno Heyd MD, Shigeki Kusamura MD, Dario Baratti MD, Konstantinos Chouliaras MD, Greg Russell MS, Perry Shen MD & Edward A. Levine MD

  2. Wake Forest School of Medicine, Winston-Salem, NC, USA

    Konstantinos I. Votanopoulos MD, PhD, FACS, Konstantinos Chouliaras MD, Greg Russell MS, Perry Shen MD & Edward A. Levine MD

  3. MedStar Washington Hospital Center, Washington, DC, USA

    Paul Sugarbaker MD

  4. IRCCS Instituto Nazionale Tumori, Milan, Italy

    Marcello Deraco MD, Shigeki Kusamura MD & Dario Baratti MD

  5. St. George Hospital, University of New South Wales, Sydney, NSW, Australia

    David Morris MD

  6. Centre Hospitalier Lyon-Sud, Lyon, France

    Olivier Glehen MD

  7. Department of Oncologic Surgery, Institut Gustave Roussy, Villejuif, France

    Dominique Elias MD

  8. Unit of Surgical Oncology, Candiolo Cancer Institute, Turin, Italy

    Michele De Simone MD & Manuela Robella MD

  9. Surgery Department, CHU Besançon, Besançon, France

    Bruno Heyd MD

Authors
  1. Konstantinos I. Votanopoulos MD, PhD, FACS
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  2. Paul Sugarbaker MD
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  3. Marcello Deraco MD
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  4. David Morris MD
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  5. Olivier Glehen MD
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  6. Dominique Elias MD
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  7. Michele De Simone MD
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  8. Manuela Robella MD
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  9. Bruno Heyd MD
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  10. Shigeki Kusamura MD
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  11. Dario Baratti MD
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  12. Konstantinos Chouliaras MD
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  13. Greg Russell MS
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  14. Perry Shen MD
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  15. Edward A. Levine MD
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Consortia

RENAPE Working Group

Corresponding author

Correspondence to Konstantinos I. Votanopoulos MD, PhD, FACS.

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Votanopoulos, K.I., Sugarbaker, P., Deraco, M. et al. Is Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy Justified for Biphasic Variants of Peritoneal Mesothelioma? Outcomes from the Peritoneal Surface Oncology Group International Registry. Ann Surg Oncol 25, 667–673 (2018). https://doi.org/10.1245/s10434-017-6293-5

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  • DOI: https://doi.org/10.1245/s10434-017-6293-5

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