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

The Annals of Thoracic Surgery 2026 May 28 [Link]

Yota Suzuki, Inderpal S Sarkaria, Edra Ha, Ian G Christie, Olugbenga T Okusanya, Omar Awais, Evan T Alicuben, Ryan M Levy, James D Luketich, Neil A Christie

Abstract

Background: 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.

Methods: 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.

Results: 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).

Conclusions: 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.