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Ann Surg Oncol. 2016 Apr;23(4):1261-70. doi: 10.1245/s10434-015-5005-2. Epub 2015 Dec 1.

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

Author information

1
Department of Digestive and Oncologic Surgery, Hospices Civils de Lyon, Centre Hospitalier Universitaire Lyon-Sud, Pierre-Bénite, France.
2
Equipe Mixte de Recherche 3738, Ecole Doctorale EDISS 205, Université Claude Bernard Lyon 1, Lyon, France.
3
Intensive Care Unit, Hospices Civils de Lyon, Centre Hospitalier Universitaire Lyon-Sud, Pierre-Bénite, France.
4
Clinical Research Unit, Hospices Civils de Lyon, Pôle IMER, Lyon, France.
5
Department of Radiology, Hospices Civils de Lyon, Centre Hospitalier Universitaire Lyon-Sud, Pierre-Bénite, France.
6
Department of Digestive and Oncologic Surgery, Hospices Civils de Lyon, Centre Hospitalier Universitaire Lyon-Sud, Pierre-Bénite, France. olivier.glehen@chu-lyon.fr.
7
Equipe Mixte de Recherche 3738, Ecole Doctorale EDISS 205, Université Claude Bernard Lyon 1, Lyon, France. olivier.glehen@chu-lyon.fr.

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.

PMID:
26628435
DOI:
10.1245/s10434-015-5005-2
[Indexed for MEDLINE]

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