Resectability of Peritoneal Carcinomatosis: Learnings from a Prospective Cohort of 533 Consecutive Patients Selected for Cytoreductive Surgery.

Abstract

PURPOSE:

The aim of this study was to identify the risk factors and causes of unresectability in a large cohort of patients with peritoneal carcinomatosis (PC) selected for cytoreductive surgery (CRS), and to assess the contribution of the different imaging modalities to the patient-selection process.

METHODS:

The pre- and intraoperative data of 533 consecutive patients with PC planned for CRS at a single institution were reviewed. All patients underwent computed tomography (CT) magnetic resonance imaging and/or positron emission tomography/CT within the 2 days prior to surgery.

RESULTS:

Among the 533 patients, 436 (82 %) underwent complete CRS, 86 (16 %) underwent exploratory laparotomy without CRS because of multiple small-bowel involvement (n = 31), invasion of different digestive segments (n = 15), an elevated PC index (n = 14), invasion of the mesenteric root (n = 12), or another cause (n = 14), and 11 (2 %) did not undergo laparotomy because of disease progression on preoperative imaging findings. On univariate analysis, elevated levels of tumor markers and a short delay between the last cycle of chemotherapy and the scheduled surgery were identified as predictors of unresectability for the colonic PC population, while a younger age was identified in patients with gastric PC. Multivariate analysis disclosed the use of neoadjuvant chemotherapy and a younger age as independent predictors of unresectability in the colonic PC population.

CONCLUSIONS:

The current modalities for the assessment of PC resectability, including functional imaging examinations, have a low impact on patient selection for CRS. New tools are needed to decrease the rate of open-close procedures.

• Authors: Kayvan Mohkam, Guillaume Passot, Eddy Cotte, Naoual Bakrin, François-Noël Gilly, Stanislas Ledochowski, Lorraine Bernard, Pierre-Jean Valette, Olivier Glehen, Pascal Rousset
• Journal: Annals of surgical oncology (Ann Surg Oncol) Vol. 23 Issue 4 Pg. 1261-70 (Apr 2016) ISSN: 1534-4681 [Electronic] United States
• PMID: 26628435 (Publication Type: Journal Article)

Topics

• Adult
• Aged
• Aged, 80 and over
• Cytoreduction Surgical Procedures
• Female
• Follow-Up Studies
• Humans
• Magnetic Resonance Imaging (methods)
• Male
• Middle Aged
• Neoplasm Staging
• Peritoneal Neoplasms (diagnostic imaging, secondary, surgery)
• Positron-Emission Tomography (methods)
• Prognosis
• Prospective Studies
• Retrospective Studies
• Survival Rate
• Tomography, X-Ray Computed (methods)
• Young Adult