Advertisement

Annals of Surgical Oncology

, Volume 25, Issue 3, pp 667–673 | Cite as

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

  • 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
  • Edward A. Levine
  • RENAPE Working Group
Gastrointestinal Oncology

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.

Notes

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.

References

  1. 1.
    Kusamura S, Adriana P, Mesa T, Cabras A, Baratti D. The role of Ki-67 and pre-cytoreduction parameters in selecting diffuse malignant peritoneal mesothelioma (DMPM) patients for cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Ann Surg Oncol. 2016;23(5):1468–73.CrossRefPubMedGoogle Scholar
  2. 2.
    Helm JH, Miura JT, Glenn JA, Marcus RK, Larrieux G, Jayakrishnan TT, et al. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for malignant peritoneal mesothelioma: a systematic review and meta-analysis. Ann Surg Oncol. 2015;22(5):1686–93.CrossRefPubMedGoogle Scholar
  3. 3.
    Yan TD, Deraco M, Baratti D, Kusamura S, Elias D, Glehen O, et al. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for malignant peritoneal mesothelioma: multi-institutional experience. J Clin Oncol. 2009;27(36):6237–42.CrossRefPubMedGoogle Scholar
  4. 4.
    Feldman BAL, Libutti SK, Pingpank JF, Bartlett DL, Beresnev TH, Mavroukakis SM, et al. Analysis of factors associated with outcome in patients with malignant peritoneal mesothelioma undergoing surgical debulking and intraperitoneal chemotherapy. J Clin Oncol. 2003;21(24):4560–7.CrossRefPubMedGoogle Scholar
  5. 5.
    Dindo D, Demartines N, Clavien P. Classification of surgical complications. Ann Surg. 2004;240(2):205–13.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Jacquet P, Sugarbaker PH. Peritoneal carcinomatosis: principles of management. Boston: Kluwer Academic Publishers. 1996. p. 359–74.CrossRefGoogle Scholar
  7. 7.
    Hermanek P, Wittekind C. The pathologist and the residual tumor (R) classification. Pathol Res Pract. 1994;190(2):115–23.CrossRefPubMedGoogle Scholar
  8. 8.
    Cloutier A, Drolet P, Hubert J, Thiboutot E, Dub P, Sideris L. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy with oxaliplatin for peritoneal mesothelioma: preliminary results and survival analysis. Surg Oncol. 2015;24(1):41–6.CrossRefPubMedGoogle Scholar
  9. 9.
    Brigand C, Monneuse O, Mohamed F, Isaac S, Gilly FN, Glehen O. Peritoneal mesothelioma treated by cytoreductive surgery and intraperitoneal hyperthermic chemotherapy: results of a prospective study. Ann Surg Oncol. 2006;13(3):405–12.CrossRefPubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2017

Authors and Affiliations

  • Konstantinos I. Votanopoulos
    • 1
    • 2
  • Paul Sugarbaker
    • 1
    • 3
  • Marcello Deraco
    • 1
    • 4
  • David Morris
    • 1
    • 5
  • Olivier Glehen
    • 1
    • 6
  • Dominique Elias
    • 1
    • 7
  • Michele De Simone
    • 1
    • 8
  • Manuela Robella
    • 1
    • 8
  • Bruno Heyd
    • 1
    • 9
  • Shigeki Kusamura
    • 1
    • 4
  • Dario Baratti
    • 1
    • 4
  • Konstantinos Chouliaras
    • 1
    • 2
  • Greg Russell
    • 1
    • 2
  • Perry Shen
    • 1
    • 2
  • Edward A. Levine
    • 1
    • 2
  • RENAPE Working Group
  1. 1.Surgical Oncology Service, Department of General SurgeryWake Forest Baptist HealthWinston-SalemUSA
  2. 2.Wake Forest School of MedicineWinston-SalemUSA
  3. 3.MedStar Washington Hospital CenterWashingtonUSA
  4. 4.IRCCS Instituto Nazionale TumoriMilanItaly
  5. 5.St. George HospitalUniversity of New South WalesSydneyAustralia
  6. 6.Centre Hospitalier Lyon-SudLyonFrance
  7. 7.Department of Oncologic SurgeryInstitut Gustave RoussyVillejuifFrance
  8. 8.Unit of Surgical OncologyCandiolo Cancer InstituteTurinItaly
  9. 9.Surgery DepartmentCHU BesançonBesançonFrance

Personalised recommendations