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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 4/2016

01-04-2016 | Gastrointestinal Oncology

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

Authors: Kayvan Mohkam, MD, Guillaume Passot, MD, PhD, Eddy Cotte, MD, PhD, Naoual Bakrin, MD, PhD, François-Noël Gilly, MD, PhD, Stanislas Ledochowski, MD, Lorraine Bernard, Msc, Pierre-Jean Valette, MD, PhD, Olivier Glehen, MD, PhD, Pascal Rousset, MD

Published in: Annals of Surgical Oncology | Issue 4/2016

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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.
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Metadata
Title
Resectability of Peritoneal Carcinomatosis: Learnings from a Prospective Cohort of 533 Consecutive Patients Selected for Cytoreductive Surgery
Authors
Kayvan Mohkam, MD
Guillaume Passot, MD, PhD
Eddy Cotte, MD, PhD
Naoual Bakrin, MD, PhD
François-Noël Gilly, MD, PhD
Stanislas Ledochowski, MD
Lorraine Bernard, Msc
Pierre-Jean Valette, MD, PhD
Olivier Glehen, MD, PhD
Pascal Rousset, MD
Publication date
01-04-2016
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 4/2016
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-015-5005-2

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