title: Treating peritoneal mesothelioma with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. A case series and review of the literature.
abstract: BACKGROUND
  Encouraging results on survival of patients with malignant peritoneal mesothelioma have been shown with the use of cytoreductive surgery and perioperative intraperitoneal chemotherapy. This study explores the impact of aggressive surgical treatment on overall survival of peritoneal mesothelioma.
  
  
  METHODS
  This is a retrospective analysis of prospectively collected clinical data of all patients with diagnosis of malignant peritoneal mesothelioma treated in a designated referral centre in Greece. All patients were offered cytoreductive surgery and intraperitoneal chemotherapy. Patient's characteristics, operative reports, pathology reports, and discharge summaries were stored in an electronic database and later reviewed and analysed.
  
  
  RESULTS
  Cytoreduction for peritoneal mesothelioma was performed on 20 patients (15 men and 5 women) with a mean age of 59.4 years (SD 16.1). Mean peritoneal cancer index was 16.1 (SD 10.4) and the median completeness of cytoreduction score was 2 (range 1-2). Mean overall survival was 46.8 months (SE 4.03) with a mean of 21.4 and median of 18 months of follow-up. Disease-specific survival was 100% for the observed period. Univariate analysis showed the completeness of cytoreduction as the only possible predictor of survival. A median of 10 (range 4-14) peritonectomy procedures were performed per patient. Median hospital stay was 14 (range 10-57 days). Grade III and IV complications occurred post-operatively in 5 patients (25%). Two patients died in the post-operative period of pulmonary embolism and myocardial infarction.
  
  
  CONCLUSIONS
  Cytoreductive surgery with HIPEC has proved the most effective treatment even when taking account of the cost of significant morbidity.
authors.affiliation: a Department of Surgical Oncology , Metropolitan Hospital , Athens , Greece .
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Stamou
authors.affiliation: a Department of Surgical Oncology , Metropolitan Hospital , Athens , Greece .
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Tsamis
authors.affiliation: a Department of Surgical Oncology , Metropolitan Hospital , Athens , Greece .
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Pallas
authors.affiliation: b Department of Anaesthesiology , Metropolitan Hospital , Athens , Greece , and.
authors.forename: Evangelia
authors.initials: E
authors.lastname: Samanta
authors.affiliation: c Department of Radiology , Democritus University of Thrace , Greece.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Courcoutsakis
authors.affiliation: c Department of Radiology , Democritus University of Thrace , Greece.
authors.forename: Panos
authors.initials: P
authors.lastname: Prassopoulos
authors.affiliation: a Department of Surgical Oncology , Metropolitan Hospital , Athens , Greece .
authors.forename: Antonios-Apostolos
authors.initials: AA
authors.lastname: Tentes
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D002945:Cisplatin / Q000008:administration & dosage / Q000627:therapeutic use; D003131:Combined Modality Therapy; D065426:Cytoreduction Surgical Procedures; D004317:Doxorubicin / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D006979:Hyperthermia, Induced; D008175:Lung Neoplasms / Q000473:pathology / Q000628:therapy*; D008297:Male; D008654:Mesothelioma / Q000473:pathology / Q000628:therapy*; D000086002:Mesothelioma, Malignant; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000473:pathology / Q000628:therapy*; D047368:Tumor Burden; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D004317:Doxorubicin; D002945:Cisplatin; D005472:Fluorouracil
keywords: HIPEC; intraperitoneal chemotherapy; mesothelioma; surgical cytoreduction