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Cytoreductive Surgery with Selective Versus Complete Parietal Peritonectomy Followed by Hyperthermic Intraperitoneal Chemotherapy in Patients with Diffuse Malignant Peritoneal Mesothelioma: A Controlled Study

  • Regional Cancer Therapies
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Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Combined treatment involving peritonectomy procedures, multivisceral resections, and hyperthermic intraperitoneal chemotherapy (HIPEC) has reportedly resulted in survival benefit for peritoneal surface malignancies, including diffuse malignant peritoneal mesothelioma (DMPM). Many unanswered questions remain regarding the surgical options in the management of DMPM. The aim of this case–control study was to assess the impact of the type and extent of parietal peritonectomy on survival and operative outcomes.

Methods

Thirty patients with DMPM undergoing selective parietal peritonectomy (SPP) of macroscopically involved regions, and 30 matched patients undergoing routine complete parietal peritonectomy (CPP), regardless of disease distribution, were retrospectively identified from a prospective database.

Results

Groups were comparable for all characteristics, except for a higher proportion of patients treated before July 2003 and undergoing preoperative systemic chemotherapy in the SPP group. Median follow-up was 86.2 months in the SPP group and 50.3 months in the CPP group. Median overall survival was 29.6 months in the SPP group and not reached in the CPP group; 5-year overall survival was 40.0% and 63.9%, respectively (P = 0.0269). At multivariate analysis, CPP versus SPP was recognized as an independent predictor of better prognosis, along with complete cytoreduction, negative lymph nodes, epithelial histology, and lower MIB-1 labelling index. Morbidity and reoperation rates were not different between groups. No operative mortality occurred. In 12 of 24 patients undergoing CPP, pathologic examination detected disease involvement on parietal surfaces with no evident tumor at surgical exploration.

Conclusions

CPP improved survival in patients with DMPM undergoing combined treatment. This information may contribute to standardize surgical options for DMPM and other peritoneal malignancies.

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References

  1. Sugarbaker PH. Evolution of cytoreductive surgery and perioperative intraperitoneal chemotherapy for peritoneal carcinomatosis: are there treatment alternatives? Am J Surg. 2011;201:157–9.

    Article  PubMed  Google Scholar 

  2. Sugarbaker PH. Peritonectomy procedures. Ann Surg. 1995;221:29–42.

    Article  PubMed  CAS  Google Scholar 

  3. Sugarbaker PH. New standard of care for appendiceal epithelial neoplasm with pseudomyxoma peritonei syndrome. Lancet Oncol. 2006;1:69–76.

    Article  Google Scholar 

  4. Yan TD, Black D, Sugarbaker PH, et al. A systematic review and meta-analysis of the randomized controlled trials on adjuvant intraperitoneal chemotherapy for resectable gastric cancer. Ann Surg Oncol. 2007;14:2702–13.

    Article  PubMed  Google Scholar 

  5. Yan TD, Deraco M, Baratti D, et al. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for malignant peritoneal mesothelioma: multi-institutional experience. J Clin Oncol. 2009;27:6237–42.

    Article  PubMed  Google Scholar 

  6. Elias D, Gilly F, Boutitie F, et al. Peritoneal colorectal carcinomatosis treated with surgery and perioperative intraperitoneal chemotherapy: retrospective analysis of 523 patients from a multicentric French study. J Clin Oncol. 2010;28:63–68.

    Article  PubMed  Google Scholar 

  7. Helm CW, Richard SD, Pan J, et al. Hyperthermic intraperitoneal chemotherapy in ovarian cancer: first report of the HYPER-O registry. Int J Gynecol Cancer. 2010;20:61–9.

    Article  PubMed  Google Scholar 

  8. Baratti D, Pennacchioli E, Kusamura S, et al. Peritoneal sarcomatosis: is there a subset of patients who may benefit from cytoreductive surgery and hyperthermic intraperitoneal chemotherapy? Ann Surg Oncol. 2010;17:3220–8.

    Article  PubMed  Google Scholar 

  9. Glehen O, Gilly FN, Boutitie F, et al. Toward curative treatment of peritoneal carcinomatosis from nonovarian origin by cytoreductive surgery combined with perioperative intraperitoneal chemotherapy: a multi-institutional study of 1290 patients. Cancer. 2010;116:5608–18.

    Article  PubMed  Google Scholar 

  10. Verwaal VJ, van Ruth S, de Bree E, et al. Randomized trial of cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and palliative surgery in patients with peritoneal carcinomatosis of colorectal origin. J Clin Oncol. 2003;21:37–43.

    Article  Google Scholar 

  11. Elias D, Lefevre JH, Chevalier J, et al. Complete cytoreductive surgery plus intraperitoneal chemohyperthermia with oxaliplatin for peritoneal carcinomatosis of colorectal origin. J Clin Oncol. 2009;27:681–5.

    Article  PubMed  Google Scholar 

  12. Franko J, Ibrahim Z, Gusani NJ, et al. Cytoreductive surgery and hyperthermic intraperitoneal chemoperfusion versus systemic chemotherapy alone for colorectal peritoneal carcinomatosis. Cancer. 2010;116:3756–62.

    Article  PubMed  Google Scholar 

  13. Yang XJ, Huang CQ, Suo T, et al. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy improves survival of patients with peritoneal carcinomatosis from gastric cancer: final results of a phase III randomized clinical trial. Ann Surg Oncol. 2011;18:1575–81.

    Article  PubMed  Google Scholar 

  14. Deraco M, Baratti D, Kusamura S, et al. Surgical technique of parietal and visceral peritonectomy for peritoneal surface malignancies. J Surg Oncol. 2009;100:321–8.

    Article  PubMed  Google Scholar 

  15. Baratti D, Kusamura S, Deraco M. Diffuse malignant peritoneal mesothelioma: systematic review of clinical management and biological research. J Surg Oncol. 2011;103:822–31.

    Article  PubMed  Google Scholar 

  16. Nonaka D, Kusamura S, Baratti D, et al. Diffuse malignant mesothelioma of the peritoneum. Cancer. 2005;104:2181–8.

    Article  PubMed  Google Scholar 

  17. Oken MM, Creech RH, Tormey DC, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol. 1982;5:649–55.

    Article  PubMed  CAS  Google Scholar 

  18. Yan TD, Haveric N, Carmignani CP, Chang D, Sugarbaker PH. Abdominal computed tomography scans in the selection of patients with malignant peritoneal mesothelioma for comprehensive treatment with cytoreductive surgery and perioperative intraperitoneal chemotherapy. Cancer. 2005;103:839–49.

    Article  PubMed  Google Scholar 

  19. Baratti D, Kusamura S, Cabras AD, et al. Lymph node metastases in diffuse malignant peritoneal mesothelioma. Ann Surg Oncol. 2010;17:45–53.

    Article  PubMed  Google Scholar 

  20. Rossi CR, Foletto M, Mocellin S, et al. Hyperthermic intraoperative intraperitoneal chemotherapy with cisplatin and doxorubicin in patients who undergo cytoreductive surgery for peritoneal carcinomatosis and sarcomatosis: phase I study. Cancer. 2002;94:492–9.

    Article  PubMed  CAS  Google Scholar 

  21. Jaquet P, Sugarbaker PH. Current methodologies for clinical assessment of patients with peritoneal carcinomatosis. J Exp Clin Cancer Res. 1996;15:49–58.

    Google Scholar 

  22. Battifora H, McCaughey WTE. Tumors of the serosal membranes. Atlas of tumor pathology, 3rd series, fascicle 15. Washington, DC: Armed Forces Institute of Pathology; 1994.

    Google Scholar 

  23. Therasse P, Arbuck SG, Eisenhauer EA, et al. New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst. 2000;92:205–16.

    Article  PubMed  CAS  Google Scholar 

  24. Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Soc. 1958;53:457–81.

    Google Scholar 

  25. Cox DR. Regression models and life tables. J R Stat Soc B. 1972;34:187–220.

    Google Scholar 

  26. Kusamura S, Baratti D, Zaffaroni N, et al. Pathophysiology and biology of peritoneal carcinomatosis. World J Gastric Oncol. 2010;15:12–8.

    Article  Google Scholar 

  27. Evers DJ, Verwaal VJ. Indication for oophorectomy during cytoreduction for intraperitoneal metastatic spread of colorectal or appendiceal origin. Br J Surg. 2011;98:287–92.

    Article  PubMed  CAS  Google Scholar 

  28. Gronchi A, Bonvalot S, Le Cesne, et al. Resection of uninvolved adjacent organs can be part of surgery for retroperitoneal soft tissue sarcoma. J Clin Oncol. 2010;27:2106–7.

    Article  Google Scholar 

  29. Ceelen WP, Bracke ME. Peritoneal minimal residual disease in colorectal cancer: mechanisms, prevention, and treatment. Lancet Oncol. 2009;10:72–9.

    Article  PubMed  Google Scholar 

  30. Yonemura Y, Kawamura T, Bandou E, et al. The natural history of free cancer cells in the peritoneal cavity. Recent results. Cancer Res. 2007;169:11–23.

    PubMed  Google Scholar 

Download references

Acknowledgment

Supported in part by grants from the Italian Association for Cancer Research (AIRC) and the Italian Health Ministry.

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Correspondence to Marcello Deraco MD.

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Baratti, D., Kusamura, S., Cabras, A.D. et al. Cytoreductive Surgery with Selective Versus Complete Parietal Peritonectomy Followed by Hyperthermic Intraperitoneal Chemotherapy in Patients with Diffuse Malignant Peritoneal Mesothelioma: A Controlled Study. Ann Surg Oncol 19, 1416–1424 (2012). https://doi.org/10.1245/s10434-012-2237-2

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  • DOI: https://doi.org/10.1245/s10434-012-2237-2

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