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Long-Term Survival in Patients Treated with Cytoreduction and Heated Intraperitoneal Chemotherapy for Peritoneal Mesothelioma at a Single High-Volume Center

  • Peritoneal Surface Malignancy
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Malignant peritoneal mesothelioma (MPM) is a rare diagnosis with a dismal prognosis if untreated. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is shown to significantly improve survival. Our institution is uniquely positioned to report long-term outcomes in MPM with CRS-HIPEC, due to our robust peritoneal surface disease program existing over the past three decades.

Methods

Our prospectively maintained, single-institution database of CRS-HIPEC cases was reviewed, identifying 111 consecutive patients with MPM over 28 years (1993–2021). Prognostic, operative, and pathologic factors were reviewed. Overall survival (OS) and conditional survival (CS) analyses were performed.

Results

The average age was 55.1 years; 58.6% of patients were male; 17 of 111 patients (15.3%) had a second CRS-HIPEC. At first CRS-HIPEC, the average PCI score was 18.7, and the perfusate drugs were platinum-based (72.1%) and mitomycin C (27.9%). The resection status at first CRS-HIPEC was R2a (46.4%), followed by R0-1 (29.1%), and R2b-c (24.5%). Median OS was 3.3 years for the entire cohort, with 75th and 25th percentiles at 10.7 months and 10.6 years. Median CS was improved if patients survived to the 1-year postoperative mark (4.9 years, p < 0.01) and trended toward further improvement with each passing year. If 3-year postoperative survival was achieved, the median CS improved to 6.1 years.

Conclusions

This represents one of the largest and lengthiest, single-center, longitudinal, case series of peritoneal mesothelioma treated with CRS-HIPEC. The OS suggests efficacy for CRS-HIPEC for MPM. Long-term survival improves significantly after patients achieve the 1-year, postoperative mark.

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Funding

Supported in part by: Wake Forest University Comprehensive Cancer Center Biostatistics shared resource funded via the NCI Grant award P30CA012197.

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Authors and Affiliations

  1. Surgical Oncology, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA

    Cristian D. Valenzuela MD, Ian B. Solsky MD, Richard A. Erali MD, Steven D. Forsythe BS, MS, Christopher W. Mangieri MD, Bigyan B. Mainali MD, Kathleen C. Perry BS, Konstantinos I. Votanopoulos MD, PhD, Perry Shen MD & Edward A. Levine MD

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

    Gregory Russell BS, MS

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This work was presented at the 2022 SSO International Conference on Surgical Cancer Care, Featuring Advanced Cancer Therapies, Dallas, TX.

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Valenzuela, C.D., Solsky, I.B., Erali, R.A. et al. Long-Term Survival in Patients Treated with Cytoreduction and Heated Intraperitoneal Chemotherapy for Peritoneal Mesothelioma at a Single High-Volume Center. Ann Surg Oncol 30, 2666–2675 (2023). https://doi.org/10.1245/s10434-022-13061-3

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