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

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Abstract

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.

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Data availability

Full study data are available if requested.

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Acknowledgements

The authors are grateful to Professor Andrea Tannapfel (The German Mesothelioma Register) for her histopathologic expert opinion.

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Authors and Affiliations

  1. Department of General and Visceral Surgery, Hospital Barmherzige Brüder, Regensburg, Germany

    Miklos Acs, Ivana Gajic, Max Mayr & Pompiliu Piso

  2. Tumor Center-Institute for Quality Management and Health Services Research, University of Regensburg, Regensburg, Germany

    Michael Gerken

  3. Gerhard Domagk Institute of Pathology, University Medical Center Muenster, Muenster, Germany

    Jozef Zustin

  4. Institute of Pathology Regensburg, Regensburg, Germany

    Jozef Zustin

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  1. Miklos Acs
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Contributions

MA: study conception and design; acquisition of data; analysis and interpretation of data; drafting of manuscript; MG Study conception and design; analysis and interpretation of data; drafting of manuscript; IG Study conception and design; acquisition of data; MM Acquisition of data; drafting of manuscript; JZ Acquisition of data; critical revision of manuscript; PP Drafting of manuscript; critical revision of manuscript.

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Correspondence to Miklos Acs.

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Acs, M., Gerken, M., Gajic, I. et al. Ten-year single-center experience with treatment of primary diffuse malignant peritoneal mesothelioma (DMPM) by cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Langenbecks Arch Surg 407, 3057–3067 (2022). https://doi.org/10.1007/s00423-022-02594-6

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