Ten-year of French multicentric experience in the management of peritoneal mesothelioma with 924 patients.

BACKGROUND

Diffuse malignant peritoneal mesothelioma (DMPM) is a rare disease for which only selected patients are eligible for cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC). The aim of our study was to evaluate oncologic outcomes of different treatments patterns of DMPM at national level.

METHODS

All patients treated for DMPM between 2012 and 2021 in France were extracted through a national administrative database. Perioperative outcomes were analyzed into 3 groups: upfront-resectable, borderline-resectable (B-R) and inoperable patients. Survival outcomes were performed by Kaplan-Meier method. A multivariate logistic model was used to identify factors affecting survival.

RESULTS

Of 924 patients, 270, 117 and 537 were identified as upfront-resectable, B-R and inoperable patients. The median age was 53 years with a mean Elixhauser comorbidity index of 3.2. Patients treated with CRS-HIPEC were younger with less comorbidities and had more exploratory laparoscopy compared to inoperable patients (p < 0.001). Majority of surgical patients were mostly treated in expert centers (97.7%). 90-day postoperative mortality (POM) was 2.1%. Major morbidity (MM) occurred in 50.9% with a failure-to-rescue (FTR) rate of 4.1%. Upfront-resectable patients had significantly better 5-year survival compared to B-R and inoperable patients (84.6% vs 55% vs 12.9%, p < 0.0001). After multivariate analysis, male gender (p < 0.0001), age (p = 0.005), B-R group (p < 0.0001), MM (p = 0.003) and adjuvant chemotherapy (p = 0.01) were independently associated with decrease 5-year survival.

CONCLUSION

CRS and HIPEC is a safe procedure with a low 90-day POM and FTR. Patients should be address to expert centers to evaluate patients that could benefit from curative strategy.