Surgical Experience Improves Outcomes in Peritoneal Mesothelioma

When it comes to surgical intervention for peritoneal mesothelioma, the most experienced centers tend to have the best outcomes. The latest study to support this idea comes from researchers in the Peritoneal Malignancy Institute in Basingstoke, UK.

The authors of the new study on peritoneal malignancies including mesothelioma published their research in the British medical journal Colorectal Disease. They performed a retrospective analysis on a database of 1,200 patients treated for peritoneal cancers since 1994. Most of these patients had a diagnosis of cancer of the appendix, but just over 5 percent had peritoneal mesothelioma.

The goal of the study was to determine trends in cancer survival after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC). For peritoneal mesothelioma, the surgery involves removing as much of the diseased peritoneal membrane as possible and then rinsing the open abdomen with heated chemotherapy drugs.

Overall, about 72 percent of patients with mesothelioma or another abdominal cancer had complete cytoreduction, meaning that their entire tumor could be removed. But when the group was divided into four sections by time period, the patients treated in the earliest quartile (1994-1998), when the doctors at North Hampshire Hospital has less experience with the procedure, had less complete surgeries than those treated most recently. Only 60.7 percent of patients in the earliest quartile had complete removal of their mesothelioma or other tumor, compared to 80.3 percent in the 2010-2014 timeframe.

Just as importantly, the number of patients with mesothelioma or anther peritoneal malignancy dying within 30 days of surgery dropped from 3 percent in the earliest quartile to just .7 percent in the latest. The five year survival rate in the 38 mesothelioma patients who had complete cytoreduction was 76 percent. The researchers credit the improved survival rates with their center’s increasing experience over time.

“A centralized approach facilitated high volume experience in a single centre with an increase in the completeness of surgical excision rates and a reduction in mortality and morbidity over time,” writes author Brendan Moran, a General Surgeon and Consultant Colorectal Surgeon at Basingstoke and North Hampshire Hospital.

Peritoneal mesothelioma accounts for approximately 300 of the 2,500 cases of mesothelioma diagnosed in the US each year. Cytoreductive surgery and HIPEC has become the gold standard treatment approach, although successful outcomes appear to be largely dependent on surgical experience.

Source:

Moran, B, et al, “The results of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in 1200 patients with peritoneal malignancy”, April 16, 2015, Colorectal Disease, Epub ahead of print