AbstractBackgroundThis case report aims to describe the impact of the bidirectional chemotherapy (BDC) on resecability for initially unresectable malignant peritoneal mesothelioma (MPM).MethodsWe report a case of 55-year-old male with the diagnosis of initially unresecable MPM. The BDC combined intravenous (IV) chemotherapy (Cisplatin–Pemetrexed) and intra peritoneal (IP) chemotherapy (Cisplatin). The response to chemotherapy was assessed by CT – scan and laparoscopy.ResultsInitial evaluation classed the disease as unresecable with PCI at 39. At the reevaluation, CT – scan and laparoscopy showed a macroscopic response, allowing surgery consisting of cytoreductive surgery and hyperthermic intra peritoneal chemotherapy (Doxorubicin and Cisplatin).ConclusionsBDC (IV and IP) has promising results and allows to undergo surgery for selected patients with borderline or initially unresectable MPM.