Feasibility and Outcomes of Cytoreductive Surgery and Hyperthermic Intrathoracic Chemoperfusion for Pleural Mesothelioma.

Abstract

The management of pleural mesothelioma requires a multidisciplinary approach, and hyperthermic intrathoracic chemoperfusion (HITHOC) after surgical cytoreduction may improve local disease control. However, with the release of the Mesothelioma and Radical Surgery 2 (MARS 2) trial results, the role of surgical intervention has been questioned because of its high perioperative mortality. This single-institution retrospective study was conducted in patients who underwent cytoreductive surgery (extrapleural pneumonectomy [EPP] or pleurectomy and decortication [PD]) and intraoperative HITHOC for pleural mesothelioma between January 2009 and December 2023. During the study period, 69 patients underwent cytoreductive surgery with HITHOC (55 PD, 14 EPP). The median age was 67 years, and 73.9% were male. Major complications (Clavien-Dindo grade ≥III) occurred in 12.7% of the PD cohort and in 50.0% of the EPP cohort. No clinically significant acute kidney injury (stage ≥2) occurred in the PD cohort, whereas it occurred in 2 patients in the EPP cohort (14.3%). There was no 90-day mortality in the PD cohort (0%), whereas 2 (14.3%) deaths were reported in the EPP cohort. In the PD cohort, adjuvant chemotherapy was administered to 33 patients (60%), and it was associated with significantly longer overall survival (median, 55.0 months vs 18.2 months; P < .001). HITHOC with PD was a feasible treatment modality, yielding excellent short-term outcomes that compare favorably with contemporary multicenter data, including MARS 2. With careful patient selection and optimization of perioperative care, HITHOC with PD may have a role for local control in pleural mesothelioma even in the post-MARS 2 era.