Systematic total parietal peritonectomy for peritoneal mesothelioma-perioperative and oncological outcomes in an Indian cohort of 100 patients.

BACKGROUND AND AIM: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is the current standard of care for patients with peritoneal mesothelioma (PeM). In this retrospective study, we evaluate the perioperative and oncological outcomes of systematic total parietal peritonectomy (TPP) which has demonstrated a significant improvement in survival compared to selective parietal peritonectomy.

METHODS

100 patients with PeM treated by CRS-HIPEC from 1st January 2013 to 31st December 2022 at three high-volume peritoneal malignancy centers were included. All patients underwent TPP irrespective of the disease extent. A multivariable Cox-regression analysis was performed to identify prognostic factors for disease-free survival (DFS).

RESULTS

Eighty-nine patients had malignant PeM (mPeM), with a median peritoneal cancer index (PCI) of 26 [IQR 20-35]. 77% had a CC0/CC1 resection. Twenty-six patients had a total small bowel mesenteric peritonectomy. 35.9% had resection of ≥1 bowel segments. The 90-day grade 3-4 morbidity was ___, and mortality 4.5%. The median overall survival (OS) and DFS were 70 months [95% confidence intervals (CI) 57- NR] and 23 months [95% CI-19-33], respectively. Ki67 > 9% (HR 9.63, p < 0.001), systemic chemotherapy use (HR 2.78, p = 0.007), and high-grade postoperative morbidity (HR 6.23, p < 0.001) were independent predictors of a poorer DFS. In 11 patients with well differentiated papillary mesothelioma, median DFS was 48 months (35-NR) and median OS 60 months (60-NR).

CONCLUSION

The morbidity of TPP combined with multi-visceral resections was established. This multi-institutional study provides the first comprehensive data on PeM with oncological outcomes from India, serving as valuable baseline information from high-volume centers.