Clinical and surgical outcomes of patients with peritoneal mesothelioma discussed at a monthly national multidisciplinary team video-conference meeting. Issue 2 (30th January 2020)

• Record Type: Journal Article
• Authors: Brandl, A; Westbrook, S; Nunn, S; Arbuthnot-Smith, E; Mulsow, J; Youssef, H; Carr, N; Tzivanakis, A; Dayal, S; Mohamed, F; Moran, B J; Cecil, T
• Is Part Of: BJS open. Volume 4:Issue 2(2020)
• Page Start: 260
• Page End: 267
• Publication Date: 2020-01-30
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1002/bjs5.50256
• Languages: English
• ISSNs: 2474-9842

Abstract

Abstract: Background: Peritoneal 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. 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. 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. Results: A 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. Conclusion: The centralized national PM MDT was effective at selecting patients suitable for CRS and HIPEC, reporting a good outcome from patient selection. Graphical Abstract: The focus of this study was to demonstrate experience in understanding, managing and treating peritoneal mesothelioma, a rare disease, and explore how this was facilitated through the establishment of a national multidisciplinary team (MDT), a model that may be useful for other rare diseases. This centralized national peritoneal mesothelioma MDT was effective at selecting patients suitable for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, and advising on the optimal treatment strategy for patients unlikely to benefit from surgery. Peritoneal mesothelioma and national MDT