title: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for malignant peritoneal mesothelioma: multi-institutional experience.
abstract: OBJECTIVE
  This multi-institutional registry study evaluated cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) for diffuse malignant peritoneal mesothelioma (DMPM).
  
  
  METHODS
  A multi-institutional data registry that included 405 patients with DMPM treated by a uniform approach that used CRS and HIPEC was established. The primary end point was overall survival. The secondary end point was evaluation of prognostic variables for overall survival.
  
  
  RESULTS
  Follow-up was complete in 401 patients (99%). The median follow-up period for the patients who were alive was 33 months (range, 1 to 235 months). The mean age was 50 years (standard deviation [SD], 14 years). Three hundred eighteen patients (79%) had epithelial tumors. Twenty-five patients (6%) had positive lymph nodes. The mean peritoneal cancer index was 20. One hundred eighty-seven patients (46%) had complete or near-complete cytoreduction. Three hundred seventy-two patients (92%) received HIPEC. One hundred twenty-seven patients (31%) had grades 3 to 4 complications. Nine patients (2%) died perioperatively. The mean length of hospital stay was 22 days (SD, 15 days). The overall median survival was 53 months (1 to 235 months), and 3- and 5-year survival rates were 60% and 47%, respectively. Four prognostic factors were independently associated with improved survival in the multivariate analysis: epithelial subtype (P < .001), absence of lymph node metastasis (P < .001), completeness of cytoreduction scores of CC-0 or CC-1 (P < .001), and HIPEC (P = .002).
  
  
  CONCLUSIONS
  The data suggest that CRS combined with HIPEC achieved prolonged survival in selected patients with DMPM.
authors.affiliation: Department of Surgery, St George Hospital, and Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia. Tristan.Yan@unsw.edu.au
authors.forename: Tristan D
authors.initials: TD
authors.lastname: Yan
authors.forename: Marcello
authors.initials: M
authors.lastname: Deraco
authors.forename: Dario
authors.initials: D
authors.lastname: Baratti
authors.forename: Shigeki
authors.initials: S
authors.lastname: Kusamura
authors.forename: Dominique
authors.initials: D
authors.lastname: Elias
authors.forename: Olivier
authors.initials: O
authors.lastname: Glehen
authors.forename: François N
authors.initials: FN
authors.lastname: Gilly
authors.forename: Edward A
authors.initials: EA
authors.lastname: Levine
authors.forename: Perry
authors.initials: P
authors.lastname: Shen
authors.forename: Faheez
authors.initials: F
authors.lastname: Mohamed
authors.forename: Brendan J
authors.initials: BJ
authors.lastname: Moran
authors.forename: David L
authors.initials: DL
authors.lastname: Morris
authors.forename: Terence C
authors.initials: TC
authors.lastname: Chua
authors.forename: Pompiliu
authors.initials: P
authors.lastname: Piso
authors.forename: Paul H
authors.initials: PH
authors.lastname: Sugarbaker
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods*; D007263:Infusions, Parenteral; D008297:Male; D008654:Mesothelioma / Q000188:drug therapy / Q000473:pathology / Q000601:surgery* / Q000628:therapy*; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D011379:Prognosis; D015996:Survival Rate
chemical_list: D000970:Antineoplastic Agents