Time till pleuropulmonary recurrence for mesothelioma and high grade appendiceal neoplasm after CRS/HIPEC

Cytoreductive surgery with heated intraperitoneal chemotherapy (CRS/HIPEC) requiring diaphragmatic stripping or resection may predispose to pleuropulmonary recurrence. This review was to assess the rates of pleuropulmonary recurrence after CRS/HIPEC for patients who had high-grade appendiceal neoplasm and meosthelioma.

A retrospective review (September 1996-November 2021) at a single tertiary center identified 716 patients who underwent CRS/HIPEC with diaphragmatic intervention; 203 had high-grade appendiceal neoplasms and 63 had mesothelioma. Radiologic or pathologic evidence of pleuropulmonary recurrence was recorded. Time from CRS/HIPEC to chest recurrence was analyzed using Kaplan-Meier methods.

Twenty patients (12 appendiceal; 8 mesothelioma) developed pleuropulmonary recurrence. In the appendiceal cohort (mean age 51.5 years; median PCI 30), all 12 underwent bilateral diaphragm intervention (four with full-thickness resection) with CCR 0-1. Time to chest recurrence ranged from 0.3 to 82.8 months; half experienced early respiratory complications (e.g., pleural effusion, pneumothorax). In the mesothelioma cohort (mean age 44.9 years; median PCI 22.1), seven had bilateral stripping (two with resection) and one had unilateral stripping; CCR was 0-1. Recurrence occurred between 8.0 and 85.4 months (median ∼31.4 months); half had early respiratory compromise. No significant associations were observed between PCI, CCR, or extent of diaphragmatic intervention and recurrence risk, although ICU stay and CCR weakly correlated with recurrence in mesothelioma.

Pleuropulmonary recurrence following CRS/HIPEC with diaphragm intervention is rare (2.7 %), with early recurrences suggesting occult thoracic involvement. Bilateral diaphragm manipulation was common among those with recurrence.