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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 1/2020

01-01-2020 | Peritoneal Surface Malignancy

Preoperative Radiographic Assessment Predicts Incomplete Cytoreduction in Patients with Low Grade Mucinous Adenocarcinoma of the Appendix

Authors: Arvind Sabesan, MD, Seth Felder, MD, Sebastian Feuerlein, MD, Cesar Lam, MD, Melissa McGettigan, MD, Benjamin D. Powers, MD, MS, Sophie Dessureault, MD, PhD, Sean P. Dineen, MD

Published in: Annals of Surgical Oncology | Issue 1/2020

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Abstract

Background

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) for patients with low-grade mucinous adenocarcinoma (LGMA) is most effective when complete cytoreduction is achieved. We externally validated two radiographic scoring systems to predict resectability and assessed radiographic response to systemic chemotherapy (SCT).

Methods

Patients with LGMA who received preoperative SCT followed by CRS/HIPEC from 2013 to 2016 were identified. CT scans were graded by six physicians using the simplified radiologic score (SRS) and simplified preoperative assessment of appendiceal tumor (SPAAT) systems. Positive and negative predictive values (PPV, NPV) were calculated by comparing to completeness of cytoreduction. Inter-rater agreement was assessed using the intraclass correlation coefficient (ICC).

Results

Twenty-four patients had preoperative SCT followed by CRS/HIPEC. Thirteen patients underwent incomplete CRS and 11 patients complete CRS. Scoring of the preoperative CT had a PPV of complete cytoreduction of 75% and 66.7% for SRS and SPAAT, respectively. NPV was 83.4% and 88.9% for SRS and SPAAT, respectively. ICC for the preoperative SRS and SPAAT score was 0.826 (95% confidence interval [CI]: 0.720–0.910] and 0.788 [0.667–0.888). Comparison of CT scans before and after SCT recorded an increase in calculated scores in 45.8% (SRS) and 50% (SPAAT) of patients.

Conclusions

External validation of two radiographic scoring systems to predict complete cytoreduction showed that inter-rater agreement for both systems was good. Both scoring systems predicted incomplete cytoreduction. Applying a systematic approach to preoperative imaging review is recommended to improve treatment selection by minimizing morbidity associated with incomplete CRS and help to set patient expectations.
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Metadata
Title
Preoperative Radiographic Assessment Predicts Incomplete Cytoreduction in Patients with Low Grade Mucinous Adenocarcinoma of the Appendix
Authors
Arvind Sabesan, MD
Seth Felder, MD
Sebastian Feuerlein, MD
Cesar Lam, MD
Melissa McGettigan, MD
Benjamin D. Powers, MD, MS
Sophie Dessureault, MD, PhD
Sean P. Dineen, MD
Publication date
01-01-2020
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 1/2020
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-019-07676-2

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