Pathological assessment of cytoreductive surgery specimens and its unexplored prognostic potential-a prospective multi-centric study

Bhatt, Aditi; Yonemura, Yutaka; Benzerdjeb, Nazim; Mehta, Sanket; Mishra, Suniti; Parikh, Loma; Kammar, Praveen; Shah, Mita; Prabhu, Aruna; Shaikh, Sakina; Patel, Mahesh D.; Isaac, Sylvie; Gléhen, Olivier

doi:10.1016/j.ejso.2019.07.019

Cited by 35 publications

(21 citation statements)

References 23 publications

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“…Imaging studies and surgical procedures were performed as normal at each centre, in accordance with the existing standards of care. A standard protocol for pathological evaluation of CRS specimens was followed [11]. An algorithm for selecting patients for CRS is provided in Fig.…”

Section: Methodsmentioning

confidence: 99%

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Prospective correlation of the radiological, surgical and pathological findings in patients undergoing cytoreductive surgery for colorectal peritoneal metastases: implications for the preoperative estimation of the peritoneal cancer index

et al. 2020

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Aim The peritoneal cancer index (PCI) is one of the strongest prognostic factors in patients undergoing cytoreductive surgery (CRS) for colorectal peritoneal metastases. Using pathological evaluation, however, the disease extent differs in a large proportion of patients. Our aim was to study the correlation between the radiological (rPCI), surgical (sPCI) and pathological (pPCI) PCI in order to determine factors affecting the discordance between these indices and their potential therapeutic implications. Method From July 2018 to December 2019, 128 patients were included in this study. The radiological, pathological and surgical findings were compared. A protocol for pathological evaluation was followed at all centres. Results All patients underwent a CT scan and 102 (79.6%) had a peritoneal MRI. The rPCI was the same as the sPCI in 81 (63.2%) patients and the pPCI in 93 (72.6%). Concordance was significantly lower for moderate-volume (sPCI 13-20) and high-volume (sPCI > 20) disease than for low-volume disease (sPCI 0-12) (P < 0.001 for sPCI; P = 0.001 for pPCI). The accuracy of imaging in predicting presence/absence of disease upon pathological evaluation ranged from 63% to 97% in the different regions of the PCI. The pPCI concurred with the sPCI in 86 (68.8%) patients. Of the nine patients with sPCI > 20, the pPCI was less than 20 in six. Conclusion The rPCI and sPCI both concurred with pPCI in approximately two thirds of patients. Preoperative evaluation should focus on the range in which the sPCI lies and not its absolute value. Radiological evaluation did not overestimate sPCI in any patient with high/moderate-volume disease. The benefit of CRS in patients with a high r/sPCI (> 20) who respond to systemic therapies should be prospectively evaluated.

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Section: Methodsmentioning

confidence: 99%

“…The protocol for pathological evaluation of CRS specimens has been described in detail elsewhere [11]. The primary colorectal tumours were analysed and reported as per the existing guidelines [17].…”

Section: Methodsmentioning

confidence: 99%

Prospective correlation of the radiological, surgical and pathological findings in patients undergoing cytoreductive surgery for colorectal peritoneal metastases: implications for the preoperative estimation of the peritoneal cancer index

et al. 2020

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“…Pathological evaluation was performed according to a predefined protocol described elsewhere for the peritoneal disease and primary tumour and involved calculation of the pathological PCI (pPCI). [18, 19, 20] Additional sections were taken from the surrounding normal peritoneum in addition to the tumor nodules at a distance of 5mm or more from the edge of the tumor nodules. The chemotherapy response score of Bohm was used to report the pathological response to systemic chemotherapy.…”

Section: Methodsmentioning

confidence: 99%

Total parietal peritonectomy leads to a low incidence of platinum resistance in patients undergoing interval cytoreductive surgery for advanced epithelial serous ovarian cancer- results of a prospective multi-centric study

Kammar

Sinukumar

Parikh³

et al. 2020

Preprint

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Background and Aim Though interval cytoreductive surgery (CRS) following neoadjuvant chemotherapy (NACT) is considered non-inferior to primary CRS, the incidence of platinum resistance is high. A total parietal peritonectomy (TPP) can address occult microscopic disease more completely and could reduce the rates of early recurrence. The early results of a prospective study evaluating the role of TPP are presented in this manuscript. Methods This is a prospective, multi-centric interventional study. A TPP was performed in all patients undergoing interval CRS. A fixed surgical protocol was followed. Grade 3-4 morbidity was recorded. Factors affecting grade 3-4 morbidity, early recurrence and progression-free survival (PFS) were evaluated. Results From July 2018, 70 patients with serous carcinoma were included. The median surgical PCI was 15 [range 5-37]. A CC-0 resection was obtained in 55(78.5%) patients; CC-1 in 10(14.2%). Grade 3-4 complications were seen in 15(21.4%) patients of which the commonest complication was intraperitoneal fluid collection. Occult disease in the peritoneum was seen in 40%. Early recurrence (platinum resistance) was seen in 5(7.1%). The median PFS was 18 months [range 0-21months]. Patients with a lower PCI and with no grade 3-4 complications had a significantly longer PFS. A pathological PCI>15 was the only independent predictor of a shorter PFS (p=0.001). Conclusions TPP performed as a part of interval CRS resulted in a very low incidence of platinum resistance. The post-operative morbidity was acceptable. These findings should be confirmed in a larger series and a randomized trial performed to demonstrate demonstrate its benefit over conventional surgery.

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“…Regional and peritoneal nodes will be evaluated as previously described. 11 The reporting of other pathological findings like evaluation of the primary tumour, if present, grade or pathological classification will be according to the existing protocols at each centre and will be captured in the data form. Similarly, the molecular markers that have been tested will be recorded with the test results.…”

Section: Pathological Evaluationmentioning

confidence: 99%

“…9 10 In our preliminary study, we found a high incidence of regional lymph node involvement related to both the primary tumour and peritoneal disease. 11 All these factors, determined on pathological evaluation, could have a prognostic impact and could influence both patient selection and the extent of surgery performed.…”

Section: Introductionmentioning

confidence: 99%

Patterns of peritoneal dissemination and response to systemic chemotherapy in common and rare peritoneal tumours treated by cytoreductive surgery: study protocol of a prospective, multicentre, observational study

et al. 2021

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IntroductionDespite optimal patient selection and surgical effort, recurrence is seen in over 70% of patients undergoing cytoreductive surgery (CRS) for peritoneal metastases (PM). Apart from the Peritoneal Cancer Index (PCI), completeness of cytoreduction and tumour grade, there are other factors like disease distribution in the peritoneal cavity, pathological response to systemic chemotherapy (SC), lymph node metastases and morphology of PM which may have prognostic value. One reason for the underutilisation of these factors is that they are known only after surgery. Identifying clinical predictors, specifically radiological predictors, could lead to better utilisation of these factors in clinical decision making and the extent of peritoneal resection performed for different tumours. This study aims to study these factors, their impact on survival and identify clinical and radiological predictors.Methods and analysisThere is no therapeutic intervention in the study. All patients with biopsy-proven PM from colorectal, appendiceal, gastric and ovarian cancer and peritoneal mesothelioma undergoing CRS will be included. The demographic, clinical, radiological, surgical and pathological details will be collected according to a prespecified format that includes details regarding distribution of disease, morphology of PM, regional node involvement and pathological response to SC. In addition to the absolute value of PCI, the structures bearing the largest tumour nodules and a description of the morphology in each region will be recorded. A correlation between the surgical, radiological and pathological findings will be performed and the impact of these potential prognostic factors on progression-free and overall survival determined. The practices pertaining to radiological and pathological reporting at different centres will be studied.Ethics and disseminationThe study protocol has been approved by the Zydus Hospital ethics committee (27 July, 2020) and Lyon-Sud ethics committee (A15-128).Trial registration numberCTRI/2020/09/027709; Pre-results.

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Pathological assessment of cytoreductive surgery specimens and its unexplored prognostic potential-a prospective multi-centric study

Cited by 35 publications

References 23 publications

Prospective correlation of the radiological, surgical and pathological findings in patients undergoing cytoreductive surgery for colorectal peritoneal metastases: implications for the preoperative estimation of the peritoneal cancer index

Prospective correlation of the radiological, surgical and pathological findings in patients undergoing cytoreductive surgery for colorectal peritoneal metastases: implications for the preoperative estimation of the peritoneal cancer index

Total parietal peritonectomy leads to a low incidence of platinum resistance in patients undergoing interval cytoreductive surgery for advanced epithelial serous ovarian cancer- results of a prospective multi-centric study

Patterns of peritoneal dissemination and response to systemic chemotherapy in common and rare peritoneal tumours treated by cytoreductive surgery: study protocol of a prospective, multicentre, observational study

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