Outcomes of multicystic peritoneal mesothelioma treatment with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

Background Multicystic peritoneal mesothelioma (MCPM) is a rare neoplasm, generally considered a borderline malignancy, best treated by cytoreductive surgery (CRS) to remove macroscopic disease, combined with hyperthermic intraperitoneal chemotherapy (HIPEC). Owing to its rarity, little has been published on clinical presentation, clinical behaviour over time, or an optimal treatment approach. Methods A prospectively developed peritoneal malignancy database was interrogated for the years 2001–2018. Details on all patients with MCPM as a definitive diagnosis after CRS and HIPEC were analysed, including previous interventions, mode of presentation, surgical treatment, postoperative outcomes, and late follow-up information from abdominal CT and tumour markers. Results Some 40 patients with MCPM underwent CRS and HIPEC between 2001 and 2018. Of these, 32 presented with abdominal pain, distension or bloating, six patients presented with recurrence following previous surgery at the referring hospitals, and two had coincidental diagnoses during a surgical procedure. CRS involved peritonectomy in all 40 patients. Bowel resection was required in 18 patients, and seven had a temporary stoma. Thirty-eight patients were considered to have undergone a complete macroscopic tumour removal (completeness of cytoreduction CC0), and two had residual tumour nodules less than 2.5 mm in size, classified as CC1. Median duration of follow-up was 65 (range 48–79) months. There were no deaths during follow-up. The Kaplan–Meier-predicted recurrence-free interval was 115.4 months. Conclusion MCPM is a rare peritoneal neoplasm with a heterogeneous pattern of presentation. CRS and HIPEC is an effective management option for this group of patients, with favourable long-term survival.

Indigenous way of hyperthermic intraperitoneal chemotherapy

Introduction: Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is a form of highly concentrated, heated chemotherapy that is delivered directly to the abdomen intra-operatively. Currently for peritoneal surface malignancy (PSM), either primary or secondary from gastrointestinal (GI) or gynecologic cancers, cytoreductive surgery (CRS) combined with peri-operative HIPEC therapy is recommended. Aims & objectives: The primary objective of this case report is to show that in the current era of malignancy, resource poor centers can adopt our innovative way of HIPEC therapy and can treat peritoneal neoplasms which were considered to have only palliative treatment. Methods: After proper pre-operative work up, 61 year old lady diagnosed with adenocarcinoma of the sigmoid colon with peritoneal deposits was taken up for cytoreductive surgery and HIPEC. In the absence of a proper HIPEC machine, we used the hotline fluid warmer used by Anesthesiologists to heat the chemotherapy solution which was then re-circulated manually. Results: The patient had an excellent post-operative recovery and was discharged in a hemodynamically stable condition on post-operative day (POD) 6. She has completed 18 months of follow-up and has no signs of recurrence. Conclusions: To treat cancer like peritoneal neoplasm in resource-poor centers, the hotline machine can be a good option.

Progression of peritoneal adenomucinosis to the scrotum: a rare occurrence treated with cytoreductive surgery and hyperthermic chemoperfusion of the scrotum in two patients

Introduction: Disseminated Peritoneal Adenomucinosis (DPAM) is an infrequent presentation of appendiceal cancer. Infrequently, umbilical or inguinal hernias could be the first clinical manifestation of this condition; DPAM extension to the scrotum may be anatomically viable. Treatment with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is the standard of treatment for DPAM. We hypothesize that these same treatment principles, consisting of CRS with hyperthermic chemoperfusion of the scrotum (HCS), could be applied to the scrotal dissemination of DPAM. Methods: We reviewed our Institution’s prospective cancer database and identified two cases of DPAM with extension to the scrotum. Their medical records were examined, and close follow-up was performed. Tumor histopathology and cytoreduction scores were evaluated. Tumor progression was monitored on follow-up by physical examination, tumor markers (CEA, CA 125, CA 19.9) and abdomino-pelvic CT scan. Results: Two patients who previously had CRS/ HIPEC for DPAM were successfully treated with HSC. Both patients are alive and free of disease at 88 and 57 months following initial CRS/HIPEC, and 50 and 32 months following CRS/HCS, respectively. Conclusion: Increased awareness by surgeons to the coexistence of inguinal hernia with peritoneal neoplasm and the need for a surgical repair is raised. CRS/HCS may be employed to treat patients with DPAM extension to the scrotum. Successful outcome is dependent on complete cytoreduction of metastatic tumor.