Annals of Surgical Oncology

, Volume 23, Issue 4, pp 1261–1270 | Cite as

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

  • Kayvan Mohkam
  • Guillaume Passot
  • Eddy Cotte
  • Naoual Bakrin
  • François-Noël Gilly
  • Stanislas Ledochowski
  • Lorraine Bernard
  • Pierre-Jean Valette
  • Olivier Glehen
  • Pascal Rousset
Gastrointestinal Oncology

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.

Keywords

Peritoneal Carcinomatosis Staging Laparoscopy Peritoneal Cancer Index Hepatoduodenal Ligament Pseudomyxoma Peritonei 

Notes

Acknowledgment

No sources of funding were used to assist in the preparation of this study.

Conflict of interest

Kayvan Mohkam, Guillaume Passot, Eddy Cotte, Naoual Bakrin, François-Noël Gilly, Stanislas Ledochowski, Lorraine Bernard, Pierre-Jean Valette, Olivier Glehen, and Pascal Rousset have no commercial interests to disclose.

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Copyright information

© Society of Surgical Oncology 2015

Authors and Affiliations

  • Kayvan Mohkam
    • 1
    • 2
  • Guillaume Passot
    • 1
    • 2
  • Eddy Cotte
    • 1
    • 2
  • Naoual Bakrin
    • 1
    • 2
  • François-Noël Gilly
    • 1
    • 2
  • Stanislas Ledochowski
    • 3
  • Lorraine Bernard
    • 4
  • Pierre-Jean Valette
    • 2
    • 5
  • Olivier Glehen
    • 1
    • 2
  • Pascal Rousset
    • 2
    • 5
  1. 1.Department of Digestive and Oncologic Surgery, Hospices Civils de LyonCentre Hospitalier Universitaire Lyon-SudPierre-BéniteFrance
  2. 2.Equipe Mixte de Recherche 3738, Ecole Doctorale EDISS 205Université Claude Bernard Lyon 1LyonFrance
  3. 3.Intensive Care Unit, Hospices Civils de LyonCentre Hospitalier Universitaire Lyon-SudPierre-BéniteFrance
  4. 4.Clinical Research Unit, Hospices Civils de LyonPôle IMERLyonFrance
  5. 5.Department of Radiology, Hospices Civils de LyonCentre Hospitalier Universitaire Lyon-SudPierre-BéniteFrance

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