Abstract
BackgroundPeritoneal mesothelioma (PM) is a rare primary neoplasm of the peritoneum with an increasing incidence worldwide. Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) has shown promise as a treatment strategy. A national PM multidisciplinary team (national PM MDT) video‐conference meeting was established in the UK and Ireland in March 2016, aiming to plan optimal treatment, record outcomes and provide evidence for the benefits of centralization. This article reports on the activities and outcomes of the first 2·5 years.MethodsBetween March 2016 and December 2018, patients with PM, referred to peritoneal malignancy centres in Basingstoke, Birmingham, Manchester and Dublin, were discussed by the national PM MDT via video‐conference. The MDT was composed of surgeons, radiologists, specialist nurses and pathologists. Patients were considered for CRS and HIPEC if considered fit for surgery and if radiological imaging suggested that complete surgical cytoreduction could be achieved. Morbidity and mortality following surgery were analysed. Survival analysis following MDT discussion was conducted.ResultsA total of 155 patients (M : F ratio 0·96) with a mean(s.d.) age of 57(17) years were discussed. To date, 22 (14·2 per cent) have had CRS and HIPEC; the median Peritoneal Cancer Index for the surgical group was 17·0. Complete cytoreduction was achieved in 19 patients. Clavien–Dindo grade I–II complications occurred in 16 patients; there was no grade III–IV morbidity or 30‐day in‐hospital mortality. The median follow‐up for the whole cohort was 18·7 months, and the 2‐year survival rate from time of first review at the national PM MDT was 68·3 per cent.ConclusionThe centralized national PM MDT was effective at selecting patients suitable for CRS and HIPEC, reporting a good outcome from patient selection.
Highlights
Mesothelioma is a rare malignancy originating from mesothelial cells of the serosal layers of the pleura, peritoneum, pericardium or tunica vaginalis testis
Histopathological subtype was available for 132 patients at the time of the national Peritoneal mesothelioma (PM) MDT review, with the epithelioid subtype in 79, sarcomatoid in one and biphasic in 13
The National Mesothelioma Audit Report[19] documented that 4 per cent of mesothelioma cases diagnosed in England were PM (260 of 7192 cases in 2014–2016)
Summary
Mesothelioma is a rare malignancy originating from mesothelial cells of the serosal layers of the pleura, peritoneum, pericardium or tunica vaginalis testis. Methods: Between March 2016 and December 2018, patients with PM, referred to peritoneal malignancy centres in Basingstoke, Birmingham, Manchester and Dublin, were discussed by the national PM MDT via video-conference. Patients were considered for CRS and HIPEC if considered fit for surgery and if radiological imaging suggested that complete surgical cytoreduction could be achieved. 22 (14⋅2 per cent) have had CRS and HIPEC; the median Peritoneal Cancer Index for the surgical group was 17⋅0. The median follow-up for the whole cohort was 18⋅7 months, and the 2-year survival rate from time of first review at the national PM MDT was 68⋅3 per cent. Conclusion: The centralized national PM MDT was effective at selecting patients suitable for CRS and HIPEC, reporting a good outcome from patient selection
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