title: Repeat cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent diffuse malignant peritoneal mesothelioma.
abstract: BACKGROUND
  Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) has shown to improve survival outcomes for patients with diffuse malignant peritoneal mesothelioma (DMPM).
  
  
  METHODS
  This is a retrospective study of prospectively collected data of 44 consecutive patients with DMPM who underwent CRS and HIPEC by the same surgical team at St George Hospital in Sydney, Australia. A total of 58 operations were performed. Clinical data were divided according to the number of operation and HIPEC the patient had undergone (Group 1 = initial CRS and HIPEC; Group 2 = 2nd CRS and HIPEC; Group 3 included 3rd CRS and HIPEC; Group 4 = 4th CRS and HIPEC). A significant difference was defined as p < 0.05.
  
  
  RESULTS
  There were no significant differences in mortality and morbidity results among the four groups. The median survival for those who only had one operation was 22 months (95% confidence interval (CI) = 0-47.2), whereas the median survival for those who had a second operation was 62 months (95% CI = 22.9-101.1). However, such a difference did not translate into a statistical significance (p = 0.141).
  
  
  CONCLUSIONS
  We report an encouraging median survival of 62 months in patients who had recurrence of disease and had repeat CRS and HIPEC with similar morbidity and mortality with the initial operation. Due to the learning curve of this technique, patients with recurrent mesothelioma should be referred to specialised tertiary care centres for evaluation. Selected patients may experience prolonged survival after repeat CRS and HIPEC.
authors.affiliation: St George Clinical School, University of New South Wales, New South Wales, Australia.
authors.forename: Y
authors.initials: Y
authors.lastname: Huang
authors.affiliation: Department of Surgery, University of New South Wales, St George Hospital, New South Wales, Australia; College of Medicine, Imam Muhammad ibn Saud Islamic University, Riyadh, Saudi Arabia.
authors.forename: N A
authors.initials: NA
authors.lastname: Alzahrani
authors.affiliation: Department of Medical Oncology, University of New South Wales, St George Hospital, Sydney, New South Wales, Australia.
authors.forename: W
authors.initials: W
authors.lastname: Liauw
authors.affiliation: Department of Surgery, University of New South Wales, St George Hospital, New South Wales, Australia. Electronic address: david.morris@unsw.edu.au.
authors.forename: D L
authors.initials: DL
authors.lastname: Morris
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001315:Australia / Q000453:epidemiology; D002945:Cisplatin / Q000008:administration & dosage; D015331:Cohort Studies; D065426:Cytoreduction Surgical Procedures / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods*; D007263:Infusions, Parenteral; D008175:Lung Neoplasms / Q000401:mortality / Q000628:therapy*; D008297:Male; D008654:Mesothelioma / Q000401:mortality / Q000628:therapy*; D000086002:Mesothelioma, Malignant; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D010534:Peritoneal Neoplasms / Q000401:mortality / Q000628:therapy*; D012086:Reoperation; D019233:Retreatment; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D016685:Mitomycin; D002945:Cisplatin
keywords: Cytoreductive surgery; Mesothelioma; Morbidity; Mortality; Reoperation; Survival