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Erschienen in: Annals of Surgical Oncology 5/2015

01.05.2015 | Regional Cancer Therapies

Iterative Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Recurrent or Progressive Diffuse Malignant Peritoneal Mesothelioma: Clinicopathologic Characteristics and Survival Outcome

verfasst von: Chukwuemeka Ihemelandu, MD, FACS, Lana Bijelic, MD, FACS, Paul H. Sugarbaker, MD, FACS, FRCS

Erschienen in: Annals of Surgical Oncology | Ausgabe 5/2015

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Abstract

Background

Diffuse malignant peritoneal mesothelioma (DMPM) is an aggressive disease for which cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have been used with remarkable survival benefits. Our aim was to analyze the clinicopathologic characteristics and prognosis of recurrent DMPM managed with iterative CRS and HIPEC.

Methods

A retrospective analysis of a prospectively maintained database for all patients treated for DMPM from 1989 to 2012.

Results

Of 205 consecutive CRS and HIPEC procedures, 44 (21.5 %) patients underwent an iterative procedure—22 (50.0 %) males versus 22 (50.0 %) females. Mean age at recurrence was 51.5 years. There was no 30-day mortality following an iterative procedure, and the grade III–V morbidity was 2.3 %. The median overall survival of patients undergoing an iterative CRS and HIPEC was 54 months versus 77 months following an initial CRS and HIPEC (p = 0.96). Patients undergoing an iterative surgery had a 3- and 5-year survival of 61 and 46 %, respectively, versus 60 and 52 % following an initial CRS and HIPEC. Amongst the iterative group, the achieved complete cytoreduction (CC) score was 15.9, 18.2, 22.7, and 43.2 % for CC0, CC1, CC2 and CC3, respectively, versus 3.1, 43.5, 28.6 and 24.8 %, respectively, following initial CRS (p = 0.000). Significant predictors of an improved survival in multivariate analysis were an epithelioid subtype, female sex, complete or near CC (CC0 or CC1), HIPEC regimen utilized, absence of postoperative complication, and age at diagnosis.

Conclusion

Iterative CRS and HIPEC can be performed safely and appear to have benefits with this group of patients showing an improved median survival.
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Metadaten
Titel
Iterative Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Recurrent or Progressive Diffuse Malignant Peritoneal Mesothelioma: Clinicopathologic Characteristics and Survival Outcome
verfasst von
Chukwuemeka Ihemelandu, MD, FACS
Lana Bijelic, MD, FACS
Paul H. Sugarbaker, MD, FACS, FRCS
Publikationsdatum
01.05.2015
Verlag
Springer US
Erschienen in
Annals of Surgical Oncology / Ausgabe 5/2015
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-014-3977-y

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