CYTOREDUCTIVE SURGERY AND HYPERTHERMIC INTRAPERITONEAL CHEMOTHERAPY IN MALIGNANT PERITONEAL MESOTHELIOMA: A CURRENT NARRATIVE REVIEW OF SURVIVAL OUTCOMES AND PROGNOSTIC FACTORS
DOI:
https://doi.org/10.31435/ijitss.3(51).2026.6278Keywords:
Malignant Peritoneal Mesothelioma, Cytoreductive Surgery, Hyperthermic Intraperitoneal Chemotherapy (HIPEC), Prognostic Factors, Survival OutcomesAbstract
Research Objectives. To summarize current evidence on survival outcomes and prognostic factors following CRS-HIPEC for MPM.
Methods. Narrative review of studies published from 2021–2026, including multicenter studies, single-center series, and international consensus guidelines (Acs et al., 2022; Deban et al., 2023; Kusamura et al., 2025; Kusamura et al., 2021; Liang et al., 2025; Noiret et al., 2026; Valenzuela et al., 2023) . Data on treatment protocols, perioperative outcomes, survival, and prognostic factors were analyzed.
Key findings. Across >1,400 patients, complete cytoreduction (CC-0/1) was achieved in 78.6–85.7% of cases (Acs et al., 2022; Deban et al., 2023). Median OS ranged from 38–42 months (Acs et al., 2022; Liang et al., 2025; Valenzuela et al., 2023) and was not reached in upfront-resectable patients (Noiret et al., 2026). Five-year OS reached 84.6% in upfront-resectable disease versus 12.9% in inoperable cases (Noiret et al., 2026), markedly exceeding outcomes with systemic chemotherapy alone (Kusamura et al., 2021). Complete resection strongly affected survival, with median OS of 127 months after R0-1 versus 3 months after R2c resection (Valenzuela et al., 2023). Favorable prognostic factors included PCI ≤20, fewer transfusions, and absence of major complications (Liang et al., 2025), whereas older age, male sex, and borderline-resectable disease predicted worse outcomes (Noiret et al., 2026). Major morbidity ranged from 16.9–50.9% (Acs et al., 2022; Deban et al., 2023; Noiret et al., 2026), while perioperative mortality remained below 4% (Kusamura et al., 2025; Kusamura et al., 2021; Liang et al., 2025; Noiret et al., 2026; Valenzuela et al., 2023). High-volume centers demonstrated lower morbidity (Noiret et al., 2026). International PSOGI guidelines strongly recommend CRS-HIPEC in carefully selected patients despite low-certainty evidence (Kusamura et al., 2025; Kusamura et al., 2021).
Conclusion. CRS-HIPEC is the current standard treatment for resectable MPM in expert centers, providing median OS exceeding 40 months and durable long-term survival in selected patients. Careful patient selection and treatment centralization optimize outcomes.
References
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Copyright (c) 2026 Julia Rurkowska, Krzysztof Drelich, Jakub Polczyk, Przemyslaw Rajzer, Filip Maciej Ogorzałek, Zofia Golińska, Wojciech Deptuch, Wiktor Szczuciński, Paweł Krzysztof Moćko, Maciej Tomasz Zając
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