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

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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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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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Authors and Affiliations

  1. Department of Digestive and Oncologic Surgery, Hospices Civils de Lyon, Centre Hospitalier Universitaire Lyon-Sud, Pierre-Bénite, France

    Kayvan Mohkam MD, Guillaume Passot MD, PhD, Eddy Cotte MD, PhD, Naoual Bakrin MD, PhD, François-Noël Gilly MD, PhD & Olivier Glehen MD, PhD

  2. Equipe Mixte de Recherche 3738, Ecole Doctorale EDISS 205, Université Claude Bernard Lyon 1, Lyon, France

    Kayvan Mohkam MD, Guillaume Passot MD, PhD, Eddy Cotte MD, PhD, Naoual Bakrin MD, PhD, François-Noël Gilly MD, PhD, Pierre-Jean Valette MD, PhD, Olivier Glehen MD, PhD & Pascal Rousset MD

  3. Intensive Care Unit, Hospices Civils de Lyon, Centre Hospitalier Universitaire Lyon-Sud, Pierre-Bénite, France

    Stanislas Ledochowski MD

  4. Clinical Research Unit, Hospices Civils de Lyon, Pôle IMER, Lyon, France

    Lorraine Bernard Msc

  5. Department of Radiology, Hospices Civils de Lyon, Centre Hospitalier Universitaire Lyon-Sud, Pierre-Bénite, France

    Pierre-Jean Valette MD, PhD & Pascal Rousset MD

Authors
  1. Kayvan Mohkam MD
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  2. Guillaume Passot MD, PhD
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  3. Eddy Cotte MD, PhD
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  4. Naoual Bakrin MD, PhD
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  5. François-Noël Gilly MD, PhD
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  7. Lorraine Bernard Msc
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  8. Pierre-Jean Valette MD, PhD
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  9. Olivier Glehen MD, PhD
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  10. Pascal Rousset MD
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Corresponding author

Correspondence to Olivier Glehen MD, PhD.

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Mohkam, K., Passot, G., Cotte, E. et al. Resectability of Peritoneal Carcinomatosis: Learnings from a Prospective Cohort of 533 Consecutive Patients Selected for Cytoreductive Surgery. Ann Surg Oncol 23, 1261–1270 (2016). https://doi.org/10.1245/s10434-015-5005-2

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  • DOI: https://doi.org/10.1245/s10434-015-5005-2

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