Intra-abdominal manifestations of pleural mesothelioma.

Malignant pleural mesothelioma is a disease characterized by persistent and progressive disease within the hemithorax. However, after aggressive local-regional treatment using surgery, regional chemotherapy, radiation therapy, and systemic chemotherapy, metastases outside of the pleural space may become the chief obstacle to long-term survival. One possible direction of cancer dissemination is direct extension through the hemidiaphragm into the peritoneal space by the disease itself or as a result of diaphragm resection. In those patients who have isolated progression of disease within the peritoneal space, evaluation of their clinical condition using prognostic indicators is essential. Patients with a limited extent of disease and favorable radiologic findings by CT should be considered for cytoreductive surgery using peritonectomy procedures and perioperative combined intraperitoneal and systemic chemotherapy. Although few patients with pleural to peritoneal disease extension have been treated, some favorable long-term results suggest that selected patients should be thoroughly evaluated for disease control within the abdominal and pelvic space.