Peritoneal metastases found in routinely resected specimens after cytoreductive surgery and heated intraperitoneal chemotherapy

Nors, Jesper; Iversen, Lene Hjerrild; Nielsen, Kjeld; Soerensen, Mette Moeller; Verwaal, Victor J.; Funder, Jonas Amstrup

doi:10.1016/j.ejso.2021.12.026

Cited by 6 publications

(4 citation statements)

References 32 publications

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“…This is slightly higher than the rate reported in other smaller series (15–20%). 12 – 14 It is unclear whether acellular mucin was included as OHOM in other series, as it was in our study, in order to maximize inclusion of histologic abnormalities. This difference may explain the higher rate of OHOM in the present study, as acellular mucin accounted for the majority of OHOM in our series.…”

Section: Discussionmentioning

confidence: 93%

“… 11 However, the rate of omental metastases in the absence of visible disease is largely unknown, although it has been estimated to be around 15–20%. 12 – 14 While the omentum has a physiologically uncertain role, there are potential risks of omentectomy, including injury to nearby structures and bleeding. Some have questioned the necessity of omentectomy for other surgical oncology procedures.…”

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confidence: 99%

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Is Routine Omentectomy a Necessary Component of Cytoreductive Surgery and HIPEC?

et al. 2022

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Background Cytoreductive surgery (CRS) with or without hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal metastases traditionally includes omentectomy, even in the absence of visible omental metastases. We sought to determine the rate of occult histologic omental metastasis (OHOM), evaluate morbidity with omentectomy, and examine the rate of omental recurrence among patients undergoing CRS-HIPEC. Methods All CRS-HIPEC procedures from August 2007 to August 2020 were included in this single-center, retrospective, cohort study. Procedures were divided into those that included greater omentectomy (OM) and those that did not (NOM). The incidence of OHOM was evaluated specifically among the OM group with a grossly normal omentum. Multivariate regression analyses were performed to evaluate return of bowel function, ileus, and morbidity in the OM and NOM groups. Results Among 683 CRS-HIPEC procedures, 578 (84.6%) included omentectomy and 105 (15.4%) did not. The OM group had higher operative time, blood loss, peritoneal cancer index, number of visceral resections, and length of stay. In the OM group, 72 (12.5%) patients had a grossly normal omentum, and 23 (31.9%) of these had OHOM. Risk-adjusted return of bowel function, ileus, and 60-day complications were no different in the OM and NOM groups. Among 43 patients with residual omentum, 24 (55.8%) recurred, including 9 (20.9%) with omental recurrence. Conclusions Histologically occult metastasis was present in one-third of patients undergoing omentectomy during CRS-HIPEC. Omentectomy did not increase the rate of overall morbidity, and one-fifth of patients with residual omentum later developed omental recurrence. Thus, omentectomy is warranted in the absence of gross metastases during CRS-HIPEC.

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Section: Discussionmentioning

confidence: 93%

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confidence: 99%

Is Routine Omentectomy a Necessary Component of Cytoreductive Surgery and HIPEC?

et al. 2022

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“…The peritoneal cavity is susceptible to containing peritoneal metastases, and it might help the clinical evolution if some anatomical formations were regularly removed. Nors [81] conducted research to see how often disease occurred in regularly resected CRS specimens. The results were that a significant number of standard surgical removals showed histologically confirmed peritoneal metastasis.…”

Section: Treatmentmentioning

confidence: 99%

Ovarian Causes of Pseudomyxoma Peritonei (PMP)—A Literature Review

Ionescu,

Marincas,

Madge

et al. 2024

Cancers

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Background. Pseudomyxoma peritonei (PMP) is a rare, progressive, slowly growing, inadequately understood neoplasm with a 5-year progression-free survival rate of as low as 48%. It is characterized by varying degrees of malignancy and the production of mucinous and gelatinous structures. Typically, the development of pseudomyxoma peritonei is associated with the rupture of appendiceal mucinous tumors and other gastrointestinal or ovarian mucinous tumors. The goal of our literature review was to identify various aspects that characterize the ovarian causes of pseudomyxoma peritonei. Materials and methods. The authors performed an extensive literature search between 1 February 2024 and 2 March 2024 on the following databases: Pubmed, Scopus, Oxford Journals, and Reaxys, and the findings were summarized into seven main clinical and paraclinical situations. Results. According to our research, the main instances in which pseudomyxoma peritonei can be triggered by an ovarian cause are the following: (1) mucinous cystadenoma; (2) mucinous ovarian cancer; (3) colon cancer with ovarian metastasis; (4) malignant transformation of an ovarian primary mature cystic teratoma; (5) appendiceal mucocele with peritoneal dissemination mimicking an ovarian tumor with peritoneal carcinomatosis; (6) mucinous borderline tumor developing inside an ovarian teratoma; and (7) the association between a mucinous bilateral ovarian cancer and a colonic tumor. Conclusions. In our study, we aimed to provide a comprehensive overview of the ovarian causes of pseudomyxoma peritonei, including its epidemiology, imagery characteristics, symptoms, current treatment, and promising future therapies, in the hopes of finding feasible solutions, as a lack of understanding of this mucus-secreting malignant disease increases the risk of delayed diagnosis or uncontrolled deterioration.

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“…An even higher rate of omental involvement (49.5%) was observed by Nors et al in a study that evaluated the incidence of metastases in routinely resected specimens during cytoreduction for colorectal cancers. 10 The authors further observed that 48.2% of routinely resected ovaries were involved with metastasis.…”

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confidence: 94%

Routine Omentectomy During Cytoreductive Surgery for Peritoneal Surface Malignancies

Young

Senthil

2022

Ann Surg Oncol

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Peritoneal metastases found in routinely resected specimens after cytoreductive surgery and heated intraperitoneal chemotherapy

Cited by 6 publications

References 32 publications

Is Routine Omentectomy a Necessary Component of Cytoreductive Surgery and HIPEC?

Is Routine Omentectomy a Necessary Component of Cytoreductive Surgery and HIPEC?

Ovarian Causes of Pseudomyxoma Peritonei (PMP)—A Literature Review

Routine Omentectomy During Cytoreductive Surgery for Peritoneal Surface Malignancies

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