Multicystic peritoneal mesothelioma treated with cytoreductive surgery followed or not by hyperthermic intraperitoneal chemotherapy: results from a large multicentric cohort

Abstract

Background

Multicystic peritoneal mesothelioma (MCPM) is a rare, slowly growing, condition prone to recur after surgery. The role of hyperthermic intraperitoneal chemotherapy (HIPEC) added to complete cytoreductive surgery (CRS) remains controversial and difficult to assess. As patients are mostly reproductive age women, surgical approach, and fertility considerations are important aspects of the management. This observational retrospective review aimed to accurate treatment strategy reflections.

Methods

The RENAPE database (French expert centers network) was analyzed over a 1999–2019 period. MCPM patients treated with CRS were included. A special focus on HIPEC, mini-invasive approach, and fertility considerations was performed.

Results

Overall 60 patients (50 women) were included with a median PCI of 10 (4–14) allowing 97% of complete surgery, followed by HIPEC in 82% of patients. A quarter of patients had a laparoscopic approach. Twelve patients (20%) recurred with a 3-year recurrence free survival of 84.2% (95% confidence interval 74.7–95.0). The hazard of recurrence was numerically reduced among patients receiving HIPEC, however, not statistically significant (hazard ratio 0.41, 0.12–1.42, p = 0.200). A severe post-operative adverse event occurred in 22% of patients with five patients submitted to a subsequent reoperation. Among four patients with a childbearing desire, three were successful (two had a laparoscopic-CRS-HIPEC and one a conventional CRS without HIPEC).

Conclusion

MCPM patients treatment should aim at a complete CRS. The intraoperative treatment options as laparoscopic approach, fertility function sparing and HIPEC should be discussed in expert centers to propose the most appropriate strategy.

Keywords:

• Multicystic mesothelioma
• cytoreductive surgery
• CRS
• hyperthermic intraperitoneal chemotherapy
• HIPEC
• fertility

Author contributions

Kepenekian: study design, data recording, results analysis, drafting manuscript; Péron: study design, results analysis, statistical analysis, drafting manuscript; Goéré: data acquisition, results analysis, manuscript revision; Sgarbura: data acquisition, results analysis, manuscript revision; Delhorme: data acquisition, results analysis, manuscript revision; Eveno: data acquisition, results analysis, manuscript revision; Benzerdjeb: pathologic analysis reviewing, results analysis, manuscript revision; Bonnefoy: data acquisition (fertility issues survey), results analysis, manuscript revision; Villeneuve: study design, data acquisition, results analysis, manuscript revision; Rousset: radiologic reviewing, study design, results analysis, manuscript revision; Abboud: data acquisition, results analysis, manuscript revision; Pocard: data acquisition, results analysis, manuscript revision; Glehen: study design, results analysis, drafting manuscript; All coauthors approved the final version of the manuscript.

Disclosure statement

Drs Kepenekian, Péron, Goéré, Sgarbura, Delhorme, Eveno, Benzerdjeb, Bonnefoy, Villeneuve, Rousset, Abboud, and Pocard report no conflict of interest or financial ties to disclose. Olivier Glehen is consultant for Gamida.

Data availability statement

Original article not based on a previous communication to a society or meeting. The authors confirm that the data supporting the findings of this study are available within the article.

Additional information

Funding

The French Network for Rare Peritoneal Tumors (RENAPE) is supported by the National Institute of Cancer (INCa). That funding source had no direct involvement in that study. There was no external funding for the manuscript production.