Symptoms, signs and radiologic findings in patients having reoperative surgery for malignant peritoneal mesothelioma.
BACKGROUND
A reasonable estimate is that 50% of patients treated with cytoreductive surgery (CRS) and perioperative chemotherapy for malignant peritoneal mesothelioma will recur. Recognition of this recurrence and knowledgeable selection for additional surgical intervention is important in improving survival of patients who progress.


METHODS
Patients treated for malignant peritoneal mesothelioma with CRS and perioperative chemotherapy were placed in follow-up for assessment of symptoms and signs and radiologic abnormalities by CT. The data were prospectively maintained and retrospectively reviewed.


RESULTS
From a database of 130 patients with malignant peritoneal mesothelioma, 38 patients who had 50 reoperations with disease recurrence that was histologically confirmed were studied. The median time to first recurrence was 14 months with a range of 3-102. Considering 50 reoperative events the most common symptoms or signs were abdominal pain (40%) and abdominal distention (34%). The most common radiologic finding was a tumor mass (56%). Patients with an abdominal or pelvic mass had a reduced prognosis (p = 0.006) and patients with an absence of radiologic abnormalities had an improved survival (p = 0.047).


CONCLUSIONS
In patients having reoperative surgery, symptoms, signs and radiologic abnormalities associated with recurrent (progressive) malignant peritoneal mesothelioma are abdominal pain, abdominal distention, and a tumor mass. An abdominal or pelvic mass was associated with a reduced prognosis and an absence of radiologic abnormalities with an improved prognosis.
Quiron Hospital, Department of General and Digestive Surgery, Torrevieja, Alicante, Spain.
M D
MD
Llanos
Program in Peritoneal Surface Malignancy, MedStar Washington Hospital Center, Washington, DC, USA. Electronic address: Paul.Sugarbaker@medstar.net.
P H
PH
Sugarbaker
D000328:Adult; D065426:Cytoreduction Surgical Procedures; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D008297:Male; D008654:Mesothelioma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D000086002:Mesothelioma, Malignant; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D010534:Peritoneal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D012086:Reoperation; D012189:Retrospective Studies; D024162:Second-Look Surgery; D015996:Survival Rate; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
CT; Concerning radiologic features; Cytoreductive surgery; HIPEC; Reoperative surgery; Second-look surgery