Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Mesothelioma: Outcomes from a Tertiary Cancer Care Center in Northern India

Abstract

Background:Malignant peritoneal mesothelioma (MPM) is a rare and aggressive form of cancer originating from the peritoneum. The prognosis for MPM has historically been poor, and treatment options are limited. This study evaluated the impact of cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) as a treatment modality for MPM, although optimal management is still evolving. Materials and Methods: This retrospective analysis included fifteen patients diagnosed with MPM between 2012 and 2023 at a tertiary referral cancer care center in North India. Patients underwent CRS followed by HIPEC. The study assessed outcomes based on overall survival (OS) and postoperative morbidity rates. Results:Demographic analysis revealed a female preponderance (60%) and a majority of younger patients, 80% of whom were younger than the age of 50. Neoadjuvant chemotherapy was infrequent (13.33%), while the most common histopathological subtype was epithelioid (66.67%). The mean peritoneal cancer index (PCI) was 14.0, with 60% of patients having a PCI above the mean. The completeness of cytoreduction (CC) varied, with 40% achieving CC0, 33.33% CC1, and 26.67% CC2. Adjuvant chemotherapy was administered to 60% of the patients. The mean blood loss was 577 ml, and the mean operation duration was 350 minutes. Postoperative complications ranged from mild to life-threatening, with a mortality rate of 6.67%. The median follow-up period was 25 months, revealing an overall median survival of 27.0 months, with 1- and 3-year survival rates of 86.7% and 33.3%, respectively. On univariate analysis, only histological subtype emerged as a predictive factor for overall survival. Conclusion: CRS combined with HIPEC is a viable and effective treatment option for patients with MPM and offers improved survival rates and an acceptable safety profile. These findings support the integration of this treatment modality into the management plan for select patients with MPM, although optimal management is still evolving.