ročník 11,2003 č.4Abstrakta
Peritonectomy and Intraperitoneal Hyperthermic Perfusion (IPHP): a promising strategy to treat patients affected by Peritoneal Mesothelioma (PM)
Deraco M., Casali P., Inglese M.G., Baratti D., Bertulli R., Kusamura S.Istituto Nazionale Tumori Milano
Melanoma and Sarcoma Unit
PurposePeritoneal mesothelioma (PM) is a rare disease, with a poor prognosis. We decided to prospectively evaluate the prognostic impact of aggressive surgery followed by intraperitoneal chemotherapy with local hyperthermia.
Patients and MethodsIn this prospective study 28 patients with PM were treated by cytoreductive surgery (CRS) and intraperitoneal hyperthermic perfusion (IPHP). Mean follow-up was 25,3 months (range: 0,4-70). Twenty-four (86%) patients had malignant disease, 2 (7%) had well-differentiated papillary mesothelioma and 2 (7%) had multicystic PM. Seventeen (58,6%) patients received preoperative chemotherapy. Twenty-one cases (72,4%) underwent optimal cytoreduction (residual disease <2.5mm). One patient underwent the procedure twice due to locoregional progression. IPHP was performed with closed abdomen technique, using a preheated polysaline perfusate (42.5°) containing cisplatin + mitomycin C or cisplatin + doxorubicin administered through a heart-lung pump for 60 or 90 minutes.
ResultsFive-year overall, disease and progression-free survival was 71, 63 and 51%, respectively. The operative morbidity (grade III), mortality and overall toxicity (grade III-IV) rates were 17%, 0% and 17%, respectively. Twenty-six (96%) out of 27 patients presenting ascites, had a resolution.
ConclusionResults observed in this series of patients confirms that patients with PM. are responsive to this aggressive therapeutic strategy with long term survival and local disease control.