Peritoneal mesothelioma, a rare pathology, difficult to diagnose positive, with multiple histological variants directing towards therapeutic strategies ranging from therapeutic abstention with surveillance to complete cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (CHIP) and / or systemic chemotherapy.
Given the rarity of certain situations, the choice of an appropriate therapeutic strategy requires a specialized diagnostic and pre-therapeutic assessment, a consultation with a surgeon specializing in the management of rare tumors of the peritoneum and a discussion in Dedicated multidisciplinary consultation meeting (RCP), RCP RENAPE (National Network for the Care of Rare Peritoneal Tumors), set up in the reference centers of this network. http://www.renape-online.fr/fr/centres.html
Nonetheless, surgeons, pathologists and oncologists who are not specialized in the management of these rare tumors, which often present themselves as peritoneal carcinomatosis at the primary undetectable level, must know the appropriate diagnostic reflexes and the main axes of therapeutic management in order to prevent diagnostic delays and inadequate initial management likely to deteriorate the prognosis.
This chapter will deal with malignant mesothelioma of the peritoneum and the so-called borderline forms, which are even rarer, multicystic mesothelioma and well-differentiated papillary mesothelioma of the peritoneum.
15.1.2. METHODOLOGY
The development of these recommendations emanates from a working group of the RENAPE network, in collaboration with the international experts of the Peritoneal Surface Oncology Group International (PSOGI) recently at the origin of published guidelines for the management of pseudomyxomas and peritoneal mesotheliomas. . (Kusamara et al. 2020) These recommendations come from questions assessed according to the Delphi method and the GRADE system was used for their grading. (Lurvink et al. 2019) The development of this consensus involved, for peritoneal mesothelioma, 38 international experts (surgeons and oncologists) from centers with experience of at least 15 cases treated per year of rare peritoneal disease and 100 procedures associating CRS and CHIP. A total of 42 questions relating to mesothelioma were submitted for evaluation using the Delphi method.
Beforehand, an exhaustive analysis of the data in the literature was carried out according to the following method:
query of the Medline® database (OVID interface) using search equations in March 2019. The bibliographic search strategy was limited to publications in French and English;
the types of studies sought were as follows: meta-analyzes on individual or published data, systematic reviews, randomized trials, controlled trials (retrospective or prospective), prospective or retrospective non-comparative studies, recommendations for clinical practice;
a selection of the relevant articles according to predefined criteria on the basis of the information contained in the abstracts then the final selection was established on the basis of the full texts;
a critical analysis of the scientific data thus selected, allowing a level of proof to be attributed to the conclusions drawn from the literature;
consultation of the relevant websites (https: //www.e-cancer.fr/, https: //www.has-sante.fr/, http: //www.fiva.fr/, http: //www.renape -online.fr/, http://www.psogi.com/).
The working group met twice in February 2018 and June 2019.
The gradation of the recommendations in this chapter corresponds to a synthesis between:
the rating of data from the literature according to the GRADE method,
the result of 3 voting rounds using the Delphi method carried out by PSOGI experts,
and the mode of presentation chosen for the TNCD according to 4 levels (A, B, C, agreement or expert opinion) (Table 1). This is summarized in Table 1.
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