{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T05:13:30Z","timestamp":1783487610890,"version":"3.55.0"},"reference-count":36,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T00:00:00Z","timestamp":1782777600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Purpose: Diffuse malignant peritoneal mesothelioma is a rare disease requiring management in specialized referral centers. We report our institutional experience with epithelioid diffuse malignant peritoneal mesothelioma, focusing on a standardized treatment algorithm and on pre-operative cisplatin\u2013pemetrexed as a bridge to cytoreductive surgery and HIPEC. Methods: Consecutive patients treated between 2016 and 2024 were retrospectively reviewed. Treatment allocation was based on diagnostic laparoscopy, PCI assessment, and multidisciplinary evaluation. Patients with technically resectable disease underwent upfront CRS\u2013HIPEC, whereas borderline or unresectable patients received cisplatin\u2013pemetrexed followed by systematic reassessment. Results: Forty-three patients were included; 19 underwent CRS\u2013HIPEC, including 8 after pre-operative chemotherapy, and 24 received medical management alone. Curative-intent cytoreduction (CC-0\/1) was achieved in all operated patients, with no 30-day mortality. No statistically significant difference in overall survival was detected between upfront and conversion surgery patients in this small cohort. Higher PCI and Ki-67 were independently associated with worse overall survival. Conclusions: A structured multidisciplinary pathway may support tailored treatment selection in epithelioid diffuse malignant peritoneal mesothelioma. In selected responders, cisplatin\u2013pemetrexed may act as a bridge to surgery, although larger studies are required to validate this strategy.<\/jats:p>","DOI":"10.3390\/cancers18132123","type":"journal-article","created":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T16:56:55Z","timestamp":1782838615000},"page":"2123","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Navigating the Foggy Landscape of Epithelioid Peritoneal Mesothelioma: A Proposed Standardized Institutional Algorithm for Multimodal Management"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-3513-8745","authenticated-orcid":false,"given":"Giorgio","family":"D\u2019Annibale","sequence":"first","affiliation":[{"name":"Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Santullo","sequence":"additional","affiliation":[{"name":"Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy"},{"name":"Catholic University of the Sacred Heart, General Surgery Residency Program, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenzo","family":"Barberis","sequence":"additional","affiliation":[{"name":"Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudio","family":"Lodoli","sequence":"additional","affiliation":[{"name":"Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-9319-8506","authenticated-orcid":false,"given":"Tommaso","family":"Partipilo","sequence":"additional","affiliation":[{"name":"Catholic University of the Sacred Heart, General Surgery Residency Program, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8627-3103","authenticated-orcid":false,"given":"Giusi Giulia","family":"La Manna","sequence":"additional","affiliation":[{"name":"Catholic University of the Sacred Heart, General Surgery Residency Program, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonia","family":"Strippoli","sequence":"additional","affiliation":[{"name":"Medical Oncology, Comprehensive Cancer Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexia","family":"Spring","sequence":"additional","affiliation":[{"name":"Medical Oncology, Comprehensive Cancer Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Pacelli","sequence":"additional","affiliation":[{"name":"Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy"},{"name":"Catholic University of the Sacred Heart, General Surgery Residency Program, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo","family":"Abatini","sequence":"additional","affiliation":[{"name":"Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,30]]},"reference":[{"key":"ref_1","first-page":"32","article-title":"Peritoneal Mesothelioma: A Review","volume":"9","author":"Alessio","year":"2007","journal-title":"Medscape General. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1686","DOI":"10.1245\/s10434-014-3978-x","article-title":"Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Malignant Peritoneal Mesothelioma: A Systematic Review and Meta-Analysis","volume":"22","author":"Helm","year":"2015","journal-title":"Ann. Surg. Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Karpes, J.B., Shamavonian, R., Dewhurst, S., Cheng, E., Wijayawardana, R., Ahmadi, N., and Morris, D.L. (2023). 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