Yan, T. D., Welch, L., Black, D. & Sugarbaker, P. H. A systematic review on the efficacy of cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for diffuse malignancy peritoneal mesothelioma. Ann. Oncol. 18, 827-834
In the past, diffuse malignant peritoneal mesothelioma (DMPM) was regarded as a preterminal condition. The length of survival was dependent upon the aggressive versus indolent biologic behavior of the neoplasm. The overall median survival was approximately 1 year after systemic chemotherapy. Cytoreductive surgery (CRS) combined with perioperative intraperitoneal chemotherapy (PIC) has been used as a treatment alternative, but the efficacy of this combined treatment remains to be established.
Searches for relevant studies published in peer-reviewed medical journals on CRS and PIC for DMPM before May 2006 were carried out on six databases. The reference lists of all retrieved articles were reviewed for further identification of potentially relevant studies. Expert academic surgeons in Washington, DC, USA were asked whether they knew about any important unpublished data. Two investigators independently evaluated each study according to predefined criteria. The quality of each study was assessed. Clinical effectiveness was synthesized through a narrative review with full tabulation of results of all included studies.
Seven prospective observational studies from six tertiary institutions were available, allowing 240 DMPM patients for assessment. The median survival ranged from 34-92 months. The 1-, 3- and 5-year survival varied from 60% to 88%, 43% to 65% and 29% to 59%, respectively. The perioperative morbidity varied from 25% to 40% and mortality ranged from 0% to 8%.
This systematic review evaluated the current evidence for CRS and PIC for DMPM. Seven observational studies were available for assessment, which demonstrated an improved overall survival, as compared to historical controls, using systemic chemotherapy and palliative surgery.
"However, there is a trend towards aggressive cytoreductive surgery and perioperative intraperitoneal chemotherapy with studies reported a better overall survival (up to 7 years), progression-free survival and near complete palliation of symptomatic ascites in centers performing aggressive surgical debulking followed by hyperthermic intraperitoneal chemotherapy with cisplatin   . The rationale behind the hyperthermic intraperitoneal chemotherapy is to deliver high concentrations of cytotoxic agents and hyperthermia directly to the peritoneal tumor, limiting systemic exposure and toxicity . "
[Show abstract][Hide abstract] ABSTRACT: Malignant mesothelioma is a rare but highly aggressive and fatal tumour arising from the mesothelial cells, which is associated with an involvement of the peritoneum in 30% of cases. We report a 48-year-old man with malignant peritoneal mesothelioma who presented with ascites of unknown origin, and discussed the clinical presentation, investigation and management, as well as the diagnostic difficulties in managing this unusual and unfortunate case.
"Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is now a common treatment for pseudomyxoma peritonei (PMP), malignant mesothelioma, peritoneal carcinomatosis (PC) from colorectal cancer (CRC) and appendiceal carcinoma, currently supported by survival, morbidity and mortality data     . "
[Show abstract][Hide abstract] ABSTRACT: Aims: Peritoneal carcinomatosis is treated with Cytoreductive surgery (CRS) and Heated Intraperitoneal Chemotherapy (HIPEC) with or without Early Postoperative Intraperitoneal Chemotherapy (EPIC) depending on the pathology involved. Since 2010 heated intraperitoneal oxaliplatin has been utilised in our institution. Our aim was to determine if there was a significant cost difference between patients receiving oxaliplatin and those requiring five additional days of EPIC. Methods: We retrospectively analysed 30 patients from our database. 15 patients underwent cytoreductive surgery, heated intraperitoneal oxaliplatin (350mg/m2) and 5-fluorouracil (FU) intravenously administered intraoperatively. We compared those patients with 15 patients who underwent CRS, heated intraperitoneal mitomycin C (10-25mg/m2) as well as EPIC with 5-FU (600-800mg/m2) on postoperative days 1 to 5. Patients were matched for age, gender, pathology and peritoneal carcinomatosis index (PCI). Results: There was no significant difference between radiology (p=0.6) and transfusion costs (p=0.4). The chemotherapy costs in the oxaliplatin group were significantly higher (p=0.001) however overall bed costs including ward, HDU and ICU were significantly lower in the oxaliplatin group (p 0.029). There was a higher percentage of patients in the EPIC group that had postoperative ileus (p 0.4), rate of infection (p 0.1), fistula formation (p 0.03), return to theatre (p 0.2) and collection formation (p 0.07) compared to the oxaliplatin group. The overall cost was significantly lower in the oxaliplatin group (p 0.038). There was no significant survival benefit between both groups (p 0.3). Conclusion: In colorectal cancer the cost and complications of EPIC following HIPEC are unjustified. We now use oxaliplatin HIPEC as our standard regimen in colorectal cancer and appendiceal adenocarcinoma.
The Open Surgical Oncology Journal 05/2014; 5(1):1-5. DOI:10.2174/1876504101405010001
"Surgery is the first choice treatment for localized tumors; however, recurrence occurs a few months after surgery and long-term survival is rarely achieved . Particularly for localized tumors, patients with positive lymph node metastasis are believed to have a poor prognosis despite tumor resection . In addition, most malignant peritoneal mesotheliomas are diffuse and difficult to resect, and therefore, in most cases, the treatment consists mainly of chemotherapy . "
[Show abstract][Hide abstract] ABSTRACT: We report an extremely rare case of resection of localized biphasic malignant peritoneal mesothelioma of the transverse colon.Case report: Computed tomography and magnetic resonance imaging in a 72-year-old man showed a tumor with enhanced borders consistent with the transverse colon. Colonoscopy showed ulcerative lesions in the transverse colon, but histological examination showed no malignancy. A gastrointestinal stromal tumor was strongly suspected, so an extended right hemicolectomy was performed. Histopathological examination showed that the tumor was a localized malignant peritoneal mesothelioma of the transverse colon. The patient did not receive postoperative chemotherapy and died 18 months after surgery.
The number of patients with malignant mesotheliomas is predicted to increase in the future both in Japan and in western countries. We report this case due to its probable usefulness in future studies pertaining to the diagnosis and treatment of malignant mesotheliomas.
World Journal of Surgical Oncology 04/2014; 12(1):112. DOI:10.1186/1477-7819-12-112 · 1.41 Impact Factor
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