Impact of histological subtype on outcomes of cytoreductive surgery with or without hyperthermic intraperitoneal chemotherapy for peritoneal mesothelioma: A systematic review and meta-analysis
In brief
Non-epithelioid mesothelioma had worse survival after surgery, but evidence is fragile
A review of 22 studies found non-epithelioid histology was associated with worse overall survival after surgery, with or without heated chemotherapy. But the main estimate rested on just 39 patients, shifted substantially when individual studies were removed, and the evidence was rated very low certainty. Histology can inform surgical selection, but the findings do not support using it alone to rule out surgery.
- Journal
- European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology (Q1)
- Published
- 24 September 2026
- Study design
- Systematic review of cohort studies
- Evidence level
- Level 2, Moderate (CEBM 2a)
- Authors
- Pablo Lozano Lominchar, Nathalie Santana Castaño, Luís González Bayón, Xin-Li Liang, Yan Li
- PMID
- 42800313
- DOI
- 10.1016/j.ejso.2026.112150
Why clinicians should know about it
- Picked for Surgical Oncology (paper of the day, 2 October 2026): Meta-analysis of CRS ± HIPEC histology impact
Abstract
BACKGROUND: Cytoreductive surgery (CRS) with or without hyperthermic intraperitoneal chemotherapy (HIPEC) has transformed survival in peritoneal mesothelioma (PeM), but is still often withheld from non-epithelioid patients on histological grounds. OBJECTIVE: To quantify the prognostic impact of non-epithelioid histology on overall survival after CRS ± HIPEC in PeM. METHODS: We searched PubMed/MEDLINE, Embase and Cochrane CENTRAL to 7 April 2026 for studies reporting survival after CRS ± HIPEC in PeM by histological subtype. Screening and extraction were duplicated. The primary analysis pooled multivariable-adjusted hazard ratios (HRs) from the institution-unique surgical cohorts; adding the two population registries was secondary (PROSPERO: CRD420261360349). RESULTS: Twenty-two studies (7017 patients) were included; six reported a multivariable-adjusted HR on an institution-unique series, four surgical. In the primary analysis, non-epithelioid histology was associated with worse overall survival (HR 3.38; 95% CI 1.22-9.35; p = 0.032; I2 = 50.3%), but the estimate is fragile: every leave-one-out iteration crossed unity (2.63 to 4.24), the prediction interval ran 0.33-34.23, and only 39 non-epithelioid patients contribute. Adding the two population registries gave 2.30 (1.21-4.37). Publication bias was not assessable at k = 4; trim-and-fill gave 2.71 (0.98-7.53). Reported whole-cohort five-year survival ranged from 39% to 52.4%, not pooled. GRADE certainty was very low. CONCLUSIONS: Non-epithelioid histology is associated with worse overall survival after CRS ± HIPEC in every analysis performed. The direction is consistent; the magnitude is not, resting on very few patients and not surviving removal of any single study. Histological subtype should inform selection for surgery rather than decide it.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.