Top

Published in:

01-03-2018 | Colorectal Cancer

Prediction of Resectability in Pseudomyxoma Peritonei with a New CT Score

Authors: Morgane Bouquot, MD, Anthony Dohan, MD, PhD, Etienne Gayat, MD, PhD, Maxime Barat, MD, Olivier Glehen, MD, PhD, Marc Pocard, MD, PhD, Pascal Rousset, MD, PhD, Clarisse Eveno, MD, PhD

Published in: Annals of Surgical Oncology | Issue 3/2018

Abstract

Background

Curative treatment of pseudomyxoma peritonei (PMP) is complete cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC).

Objective

The aim of this study was to build and evaluate a preoperative imaging score to predict resectability.

Patients and methods

Between 2007 and 2014, all PMP patients in two tertiary reference centers who underwent laparotomy with intent to undergo CRS and HIPEC were included in this study retrospectively. Thickness of tumor burden was measured on preoperative multidetector-row computed tomography (MDCT) by two radiologists blinded to surgical results in five predetermined areas. Patients were divided into two cohorts with the same resectability rate (building and validation). The performances of the scores were assessed using receiver operating characteristic (ROC) curve analyses.

Results

Overall, 126 patients were included, with compete CRS being achieved in 91/126 patients (72.2%). Two cohorts of 63 patients matched by age, sex, burden of disease, resectability rate, and pathological grade were constituted. The MDCT score was the sum of the five measures, and was higher in unresectable disease [median 46.2 mm (range 27.9–74.6) vs. 0.0 mm (range 0.0–14.0), p < 0.001]. Area under the ROC curve was 0.863 (range 0.727–0.968) and 0.801 (range 0.676–0.914) in the building and validation cohorts, respectively. A threshold of 28 mm yielded a sensitivity, specificity, positive predictive and negative predictive value of 94, 81, 81 and 94% in the building cohort, and 80, 68, 59 and 85% in the validation cohort, respectively. Using our score, overall and disease-free survival were increased in the group classified as resectable.

Conclusion

A simple preoperative MDCT score measuring tumor burden in the perihepatic region is able to predict resectability and survival of PMP patients.

Smeenk RM, Verwaal VJ, Zoetmulder FA. Pseudomyxoma peritonei. Cancer Treat Rev. 2007;33(2):138–45.CrossRefPubMed

Ronnett BM, Shmookler BM, Sugarbaker PH, Kurman RJ. Pseudomyxoma peritonei: new concepts in diagnosis, origin, nomenclature, and relationship to mucinous borderline (low malignant potential) tumors of the ovary. Anat Pathol. 1997;2:197–26.PubMed

Slim K, Blay JY, Brouquet A, et al. Digestive oncology: surgical practices [in French]. J Chir (Paris). 2009;146(Suppl 2):S11–S80.

Moran BJ, Cecil TD. The etiology, clinical presentation, and management of pseudomyxoma peritonei. Surg Oncol Clin N Am. 2003;12(3):585–603.CrossRefPubMed

Elias D, Gilly F, Quenet F, et al. Pseudomyxoma peritonei: a French multicentric study of 301 patients treated with cytoreductive surgery and intraperitoneal chemotherapy. Eur J Surg Oncol. 2010;36(5):456–62.CrossRefPubMed

Passot G, Vaudoyer D, Villeneuve L, et al. What made hyperthermic intraperitoneal chemotherapy an effective curative treatment for peritoneal surface malignancy: a 25-year experience with 1,125 procedures. J Surg Oncol. 2016;113(7):796–803.CrossRefPubMed

Chua TC, Moran BJ, Sugarbaker PH, et al. Early- and long-term outcome data of patients with pseudomyxoma peritonei from appendiceal origin treated by a strategy of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. J Clin Oncol. 2012;30(20):2449–56.CrossRefPubMed

Baratti D, Kusamura S, Milione M, et al. Pseudomyxoma peritonei of extra-appendiceal origin: a comparative study. Ann Surg Oncol. 2016;23(13):4222–30.CrossRefPubMed

Ansari N, Chandrakumaran K, Dayal S, Mohamed F, Cecil TD, Moran BJ. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in 1000 patients with perforated appendiceal epithelial tumours. Eur J Surg Oncol. 2016;42(7):1035–41.CrossRefPubMed

10.

Loungnarath R, Causeret S, Brigand C, Gilly FN, Glehen O. Pseudomyxoma peritonei: new concept and new therapeutic approach [in French]. Ann Chir. 2005;130(2):63–69.CrossRefPubMed

11.

Delhorme JB, Elias D, Varatharajah S, et al. Can a Benefit be Expected from Surgical Debulking of Unresectable Pseudomyxoma Peritonei? Ann Surg Oncol. 2016;23(5):1618–24.CrossRefPubMed

12.

Sulkin TV, O’Neill H, Amin AI, Moran B. CT in pseudomyxoma peritonei: a review of 17 cases. Clin Radiol. 2002;57(7):608–13.CrossRefPubMed

13.

Diop AD, Fontarensky M, Montoriol PF, Da Ines D. CT imaging of peritoneal carcinomatosis and its mimics. Diagn Interv Imaging. 2014;95(9):861–72.CrossRefPubMed

14.

Menassel B, Duclos A, Passot G, et al. Preoperative CT and MRI prediction of non-resectability in patients treated for pseudomyxoma peritonei from mucinous appendiceal neoplasms. Eur J Surg Oncol. 2016;42(4):558–66.CrossRefPubMed

15.

Chua TC, Al-Zahrani A, Saxena A, et al. Determining the association between preoperative computed tomography findings and postoperative outcomes after cytoreductive surgery and perioperative intraperitoneal chemotherapy for pseudomyxoma peritonei. Ann Surg Oncol. 2011;18(6):1582–89.CrossRefPubMed

16.

Sugarbaker PH. Peritonectomy procedures. Ann Surg. 1995;221(1):29–42.CrossRefPubMedPubMedCentral

17.

Sugarbaker PH. Pseudomyxoma peritonei. A cancer whose biology is characterized by a redistribution phenomenon. Ann Surg. 1994;219(2):109–11.CrossRefPubMedPubMedCentral

18.

Jacquet P, Sugarbaker PH. Clinical research methodologies in diagnosis and staging of patients with peritoneal carcinomatosis. Cancer Treat Res. 1996;82:359–74.CrossRefPubMed

19.

Benhaim L, Honore C, Goere D, Delhorme JB, Elias D. Huge pseudomyxoma peritonei: Surgical strategies and procedures to employ to optimize the rate of complete cytoreductive surgery. Eur J Surg Oncol. 2016;42(4):552–57.CrossRefPubMed

20.

Dohan A, Hoeffel C, Soyer P, et al. Evaluation of the peritoneal carcinomatosis index with CT and MRI. Br J Surg. 2017;104(9):1244–49.CrossRefPubMed

21.

Jacquet P, Jelinek JS, Chang D, Koslowe P, Sugarbaker PH. Abdominal computed tomographic scan in the selection of patients with mucinous peritoneal carcinomatosis for cytoreductive surgery. J Am Coll Surg. 1995;181(6):530–38.PubMed

22.

Esquivel J, Sticca R, Sugarbaker P, et al. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the management of peritoneal surface malignancies of colonic origin: a consensus statement. Society of Surgical Oncology. Ann Surg Oncol. 2007;14(1):128–33.CrossRefPubMed

23.

Low RN, Sebrechts CP, Barone RM, Muller W. Diffusion-weighted MRI of peritoneal tumors: comparison with conventional MRI and surgical and histopathologic findings–a feasibility study. AJR Am J Roentgenol. 2009;193(2):461–70.CrossRefPubMed

24.

Klumpp B, Aschoff P, Schwenzer N, et al. Correlation of preoperative magnetic resonance imaging of peritoneal carcinomatosis and clinical outcome after peritonectomy and HIPEC after 3 years of follow-up: preliminary results. Cancer Imaging. 2013;13(4):540–47.CrossRefPubMed

25.

Passot G, Glehen O, Pellet O, et al. Pseudomyxoma peritonei: role of 18F-FDG PET in preoperative evaluation of pathological grade and potential for complete cytoreduction. Eur J Surg Oncol. 2010;36(3):315–23.CrossRefPubMed

26.

Dubreuil J, Giammarile F, Rousset P, et al. FDG-PET/ceCT is useful to predict recurrence of Pseudomyxoma peritonei. Eur J Nucl Med Mol Imaging. 2016;43(9):1630–37.CrossRefPubMed

27.

Dohan A, Barral M, Eveno C, et al. Prediction of clinical outcome using blood flow volume in the superior mesenteric artery in patients with pseudomyxoma peritonei treated by cytoreductive surgery. Eur J Surg Oncol. 2017;43(10):1932–38.CrossRefPubMed

28.

Valle M, Garofalo A. Laparoscopic staging of peritoneal surface malignancies. Eur J Surg Oncol. 2006;32(6):625–27.CrossRefPubMed

29.

Pomel C, Appleyard TL, Gouy S, Rouzier R, Elias D. The role of laparoscopy to evaluate candidates for complete cytoreduction of peritoneal carcinomatosis and hyperthermic intraperitoneal chemotherapy. Eur J Surg Oncol. 2005;31(5):540–43.CrossRefPubMed

30.

Najah H, Lo Dico R, Grienay M, Dohan A, Dray X, Pocard M. Single-incision flexible endoscopy (SIFE) for detection and staging of peritoneal carcinomatosis. Surg Endosc. 2016;30(9):3808–815.CrossRefPubMed

31.

Ladjici Y, Dray X, Marteau P, Valleur P, Pocard M. Flexible versus rigid single-port peritoneoscopy: a randomized controlled trial in a live porcine model followed by initial experience in human cadavers. Surg Endosc. 2012;26(9):2651–57.CrossRefPubMed

32.

Najah H, Lo Dico R, Dohan A, Marry L, Eveno C, Pocard M. A feasibility study of the use of computed virtual chromoendoscopy for laparoscopic evaluation of peritoneal metastases. Surg Endosc. 2017;31(2):743–51.CrossRefPubMed

33.

Pocard M, Eveno C, Valleur P. Regarding “two steps procedure for pseudomyxoma”. Ann Surg Oncol. 2011;18(1):282–83; author reply 284–85.

34.

Dayal S, Taflampas P, Riss S, et al. Complete cytoreduction for pseudomyxoma peritonei is optimal but maximal tumor debulking may be beneficial in patients in whom complete tumor removal cannot be achieved. Dis Colon Rectum. 2013;56(12):1366–72.CrossRefPubMed

Title: Prediction of Resectability in Pseudomyxoma Peritonei with a New CT Score
Authors: Morgane Bouquot, MD
Anthony Dohan, MD, PhD
Etienne Gayat, MD, PhD
Maxime Barat, MD
Olivier Glehen, MD, PhD
Marc Pocard, MD, PhD
Pascal Rousset, MD, PhD
Clarisse Eveno, MD, PhD
Publication date: 01-03-2018
Publisher: Springer International Publishing
Published in: Annals of Surgical Oncology / Issue 3/2018
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-017-6275-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Prediction of Resectability in Pseudomyxoma Peritonei with a New CT Score

Abstract

Background

Objective

Patients and methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Objective

Patients and methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 3/2018

Implications of Hyperthermic Intraperitoneal Chemotherapy Perfusion-Related Hyperglycemia

Global Variations in the Level of Cancer-Related Research Activity and Correlation to Cancer-Specific Mortality: Proposal for a Global Curriculum

Neoadjuvant Therapy Versus Upfront Resection for Pancreatic Cancer: The Actual Spectrum and Clinical Burden of Postoperative Complications

Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for the Elderly: Is It Reasonable? A Meta-Analysis

Histologic Predictors of Recurrence in Mucinous Appendiceal Tumors with Peritoneal Dissemination after HIPEC

External Beam Radiation Therapy for Resectable Soft Tissue Sarcoma: A Systematic Review and Meta-Analysis