Malignant Peritoneal Mesothelioma

Malignant peritoneal mesothelioma (MPM) is an incurable disease. It represents approximately 15% of all mesotheliomas and has a male predominance. It has a known relationship to asbestos, but most patients present with no known history of exposure. Simian virus 40 (SV40) exposure is potentially another risk factor, although the relationship is not entirely supported. Patients usually present with vague symptoms. Diagnosis is usually made on the basis of a CT scan and percutaneous or open biopsy. The disease remains confined to the abdominal cavity until very late in the disease course. Ascites is a frequent sign; morbidity and mortality are usually a consequence of disease progression within the abdominal cavity. Systemic chemotherapy and radiation have not yet been shown to have much influence over the natural history of the disease. In selected patients, surgical cytoreduction with intraoperative hyperfhermic peritoneal chemotherapy is associated with long-term survival. A summary of clinical experience with surgical cytoreduction and intraoperative intraperitoneal chemotherapy for MPM is presented.