CYTOREDUCTIVE SURGERY AND HYPERTHERMIC INTRAPERITONEAL CHEMOTHERPAY FOR PATIENTS WITH MALIGNANT DIFFUSED MESOTHELIOMA OF THE ABDOMINAL CAVITY
Eliahu Y. Bekhor*1,2, Brianne Sullivan1, Daniel Solomon1,2, Natasha DeNicola1, Margaret Hofstedt1, Jacquelyn Carr1, Nathan M. Bolton1, Deepa Magge1, Benjamin Golas1, Daniel Labow1, Umut Sarpel1
1Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY; 2Department of surgery, Rabin medical center, Petach Tikva, Israel
Introduction: Malignant Diffuse Mesothelioma (MDM) is a rare tumor with strong correlation to asbestos exposure. The prognosis of this disease may be improved by the introduction of cytoreductive surgery and heated intraperitoneal chemotherapy (CRSHIPEC) in select patients. However, the diffuse nature of this disease may make optimal cytoreduction challenging. We aimed to study this feature of MDM impacts perioperative outcomes, as compared to patients with peritoneal carcinomatosis (PC) of other origins undergoing CRSHIPEC.
Methods: We analyzed all patients with PC due to MDM undergoing CRS/HIPEC at our institution from a prospectively maintained database in the years 2007-2018. 24 patients with MDM underwent CRS/HIPEC. This group was compared to 394 patients with PC who underwent CRS/HIPEC due to other malignant origins in the same period of time.
Results: Perioperative course was comparable (p=NS) between MDM group to the non MDM group in terms of age (mean, years, 57 vs 53), gender (female, 62% vs. 62%), ASA score (mean, 3.0 vs. 2.9), PCI (mean, 15 vs 12), number of excised organs (mean, 2.9 vs. 3.5), ablation (%, 42 vs 28), optimal CRS (%, 79 vs 87), operative time (mean, 344 vs. 326), 30 days Clavien-Dindo of IIIIV (%, 29 vs 19), 90 days mortality (%, 4 vs. 3), and long term major complications ( %, 12 vs. 22). At a median follow-up of 24 months, 13 (54%) MDM patients had recurrence; for those patients, seven (45%) received chemotherapy and one (4%) got a second operation. Mean disease free survival was 16 months and mean overall survival was 26 months.
Conclusion: Despite its diffuse nature, CRSHIPEC for mesothelioma is as safe as CRS/HIPEC for other malignancies with similar short- term and long term outcomes.
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