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Mesenteric Peritonectomy as the Seventh Peritonectomy Technique in Cytoreductive Surgery for Peritoneal Surface
Francesca Laura Nava1,2, Tommaso Cavalleri3, Dario Baratti3
1Peritoneal Surface Malignancies Unit, IRCCS Istituto Nazionale Tumori Milano, Milan, Italy. francescalauranava@gmail.com.
Background:
Mesenteric involvement represents a major challenge in cytoreductive surgery (CRS) for peritoneal surface malignancies, historically regarded as a relative contraindication to complete cytoreduction. Mesenteric peritonectomy (MP), first described by Deraco et al. in 2009, selectively removes the peritoneal layer at the bowel-mesentery interface. Despite growing interest in its clinical application, robust outcome data from comparative studies remain lacking.
Methods:
This retrospective, single-center study included 391 consecutive patients undergoing CRS-hyperthermic intraperitoneal chemotherapy at Fondazione IRCCS Istituto Tumori di Milano (2016-2024). MP was classified as partial, subtotal, or total. The primary endpoint was major postoperative morbidity (National Cancer Institute Common Terminology Criteria for Adverse Events grade ≥3); secondary endpoints included operative time, small bowel resections, completeness of cytoreduction, Comprehensive Complication Index, length of hospital stay, reoperation rate, and in-hospital mortality. A 1:1 propensity score-matched analysis compared subtotal/total MP patients with controls.
Results:
MP was performed in 76 patients (19.4%), predominantly for diffuse malignant peritoneal mesothelioma and serous papillary peritoneal carcinoma. In the matched cohort (n = 28 per group), MP was not associated with increased major morbidity (odds ratio 1.06; 95% confidence interval 0.37-3.06, p = 0.91), Comprehensive Complication Index, length of hospital stay, or reoperation rate. MP was associated with a longer operative time (+63 min; p = 0.005) and a higher likelihood of small bowel resection (odds ratio 6.4; 95% confidence interval 2.7-15.2; p < 0.001). No in-hospital deaths occurred in the MP group.
Conclusions:
MP was a safe extension of CRS, as reflected by the high rate of complete cytoreduction. Despite increased surgical complexity, it was not associated with a significant increase in major morbidity, supporting its adoption at experienced centers.
