Long-term results of laparoscopic cytoreductive surgery and HIPEC for the curative treatment of low-grade pseudomyxoma peritonei and multicystic mesothelioma

Abstract

Background

Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) provide long-term survival for low-grade pseudomyxoma peritonei (PMP) and multicystic peritoneal mesothelioma (MM). Feasibility of laparoscopic CRS-HIPEC has been reported for selected patients but data regarding long-term outcomes are missing to assess the oncological interest. This study aimed to report long-term outcomes for low-grade PMP and MM treated by laparoscopic approach.

Methods

From a prospectively maintained CRS-HIPEC database, all patients who underwent laparoscopic CRS-HIPEC with curative intent were analyzed. Selection criteria for laparoscopic approach were low-grade PMP or MM, with pathological confirmation prior to CRS-HIPEC, ASA 2, age < 75 years, no extrap-eritoneal disease, Peritoneal Cancer Index (PCI) < 10, and a limited history of abdominal surgery.

Results

Between March 2009 and June 2017, 43 patients were scheduled for laparoscopic CRS and HIPEC. Laparoscopic CRS and HIPEC was completed (LSC) in 32 patients and 11 patients were converted to open surgery (CONV). Median age was 44.5 years (17.13–71.4) in the LSC group and 54.9 years (22.5–70.5) in the CONV group (p = 0.086). Median BMI was not different between groups, 21.2 and 23.9 for LSC and CONV groups, respectively (p = 0.267). There were 21 and 11 patients in the LSC group, and 8 and 3 in the CONV group, with PMP and MM, respectively (p = 0.794). Median PCI was 2.5 (0–9) and 7 (1–15) in the LSC and CONV groups, respectively (p = 0.004). There was no difference in the completeness of cytoreduction score (p = 0.256). After a median follow-up of 31.6 months (95% CI 19.3–36.4), 2 patients in the LSC group and 2 patients in the CONV group presented with peritoneal recurrence.

Conclusion

For selected patients with low aggressive peritoneal disease, laparoscopic CRS-HIPEC provides interesting long-term outcomes.

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Acknowledgements

The authors thank Isabelle Bonnefoy for her help with data collection. They also thank Evelyne Decullier, Christelle Marolho, and Lorraine Bernard for their help with statistical analysis and Keriane Boulva for manuscript final revision.

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Correspondence to Frederic Mercier.

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F. Mercier, J. Guedj, M. Alyami, D. Vaudoyer, V. Kepenekian, P. Rousset, S. Isaac, G. Passot and O. Glehen have no conflicts of interest or financial ties to disclose. None of the authors received any payments for any aspect of this work.

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Mercier, F., Jeremie, G., Alyami, M. et al. Long-term results of laparoscopic cytoreductive surgery and HIPEC for the curative treatment of low-grade pseudomyxoma peritonei and multicystic mesothelioma. Surg Endosc 34, 4916–4923 (2020). https://doi.org/10.1007/s00464-019-07280-1

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Keywords

  • Peritoneal carcinomatosis
  • Peritoneal carcinosis
  • HIPEC
  • Cytoreductive surgery
  • Laparoscopic HIPEC
  • Laparoscopy
  • Low grade appendicular mucinous neoplasm
  • Pseudomyxoma peritonei
  • Multicystic mesothelioma