Surgical management for peritoneal carcinomatosis of appendiceal origin with a high-tumor burden

Kitai, Toshiyuki; Yamanaka, Kenya; Sugimoto, Naoko; Inamoto, Osamu

doi:10.1007/s00595-019-01856-z

Cited by 7 publications

(7 citation statements)

References 33 publications

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“…On the other hand, resectability is a major prognostic factor for PMP patients, and anticipating the level of resectability could influence the treatment strategy [ 4 , 11 , 29 , 30 , 31 ]. Achieving a complete CRS in high-peritoneal-load disease requires extensive cytoreduction, increasing the risk of severe postoperative complications and the deterioration of quality of life [ 12 , 13 , 14 , 15 , 19 , 20 ]. Predicting the risk of unresectability allows for appropriate surgical planning, based on maximal tumour debulking or, for some authors, on a two-step CRS [ 42 , 43 ].…”

Section: Discussionmentioning

confidence: 99%

“…With systemic dissemination being very rare [ 8 ], that prognosis is driven by two main factors: the post-CRS residual disease, rated by the Completeness of Cytoreduction score (CC-score) and the pathologic characteristics defining low- and high-grade disease [ 4 , 9 , 10 , 11 ]. As patients often present with diffuse disease, extensive resections are required to reach a complete CRS, including multiple digestive and peri-hepatic resections, leading to high rates of severe postoperative complications, which are prone to affecting patients’ quality of life and prognosis [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ]. Despite a complete CRS and HIPEC, half of high-grade patients and a quarter of low-grade ones recur [ 16 , 18 , 21 ].…”

Section: Introductionmentioning

confidence: 99%

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Scalloping of the Liver and Spleen on Preoperative CT-Scan of Pseudomyxoma Peritonei Patients: Impact on Prediction of Resectability, Grade, Morbidity and Survival

Képénékian

Kefleyesus

Keskin

et al. 2022

Cancers

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Pseudomyxoma peritonei (PMP) is ideally treated by cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC), leading to significant morbidity. Beyond the histologic grade, the prognosis lies in the completeness of cytoreduction (CC-score of 0/1 vs. 2/3) and the severe complication rate. The mucinous nature of the peritoneal implants sometimes induces liver and/or spleen scalloping on imaging. The predictive value of scalloping was assessed regarding resectability, grade, survival and severe morbidity. This monocentric, retrospective analysis compared CC-0/1 with CC-2/3 groups regarding liver and spleen scalloping parameters, assessed on pre-operative computed tomography (CT) scan, reviewed for the study. In addition, prognostic factors of severe complications and recurrence-free and overall survivals were explored in the CC-0/1 population. Overall, 129 patients were included (109 CC-0/1, 20 CC-2/3), with 58 (45%) exhibiting scalloping. All patients with splenic scalloping also had a liver one. Scalloping was more frequent (75% vs. 39%), with greater median maximal depth (21 vs. 11 mm) and higher PCI (32 vs. 14) in the CC-2/3 population, but was not predictive of either grade or survival. In CC-0/1 patients, survivals and postoperative complications were not affected by scalloping parameters. Scalloping appeared as a marker of advanced PMP, but was not predictive of grade, severe complications, or long-term outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Scalloping of the Liver and Spleen on Preoperative CT-Scan of Pseudomyxoma Peritonei Patients: Impact on Prediction of Resectability, Grade, Morbidity and Survival

Képénékian

Kefleyesus

Keskin

et al. 2022

Cancers

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“…Thus, as complete CRS is directly related to survival, the PCI score can indirectly predict survival through its ability to anticipate the completeness of the cytoreductive resection (17,18). For this reason, PCI and CC0 are predictors of long-term survival outcomes in patients with PC secondary to high-grade appendiceal cancer (19)(20)(21)(22)(23)(24)(25). In addition, there is no PCI limit above which a complete CRS/HIPEC cannot yield survival benefit (18).…”

Section: Discussionmentioning

confidence: 99%

Second-look Surgery for Appendiceal High Grade and Colorectal Cancers Following Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

BREAKEIT

LIU

CHENG

et al. 2022

In Vivo

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Background/Aim: Up to a third of patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal carcinomatosis (PC) of appendiceal or colorectal origin receive a stoma during primary surgery. Stoma reversal provides an opportunity for second-look surgery. Patients and Methods: We performed a retrospective analysis of prospectively collected data of patients with colorectal cancer (CRC) or high-grade appendiceal cancer (AC) from 2006 to 2021 from our database. A total of 34 consecutive stoma closure patients with no evidence of preoperative disease recurrence (tumor markers and CT scans) were compared with 141 consecutive re-do CRS/HIPEC patients with known recurrence. Results: Eleven patients (32.4%) were identified to have peritoneal recurrence at stoma closure. Time between first and second CRS was 12 months (4 to 64.2) in the stoma closure group vs. 24.6 months (5.8 to 119.8) in the re-do group, while median peritoneal cancer index (PCI) was 4 (3 to 6) vs. 8 (1 to 39), respectively (p=0.0143). Conclusion: Second-look laparotomy during stoma closure identified unexpected PC in 32.4% of our patients with significantly lower PCI than planned re-do operations.In recent decades, cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) for select patients with peritoneal carcinomatosis (PC) has shown improved survival rates compared to systemic chemotherapy with or without palliative surgery (1-5). One meta-analysis has shown that CRS with HIPEC offers a median survival of 29 months in patients with PC, which is significantly longer than the median survival of 17.9 months for standard chemotherapy alone (6).Despite advancements in CRS and HIPEC, peritoneal disease recurrence rates in colorectal cancer (CRC) or highgrade appendiceal cancer (AC) can be as high as 80% and 40%, respectively, within two years of surgery (7, 8). Currently, postoperative monitoring consists primarily of routine cross-sectional imaging by way of computed tomography (CT) scan, combined with serum biochemical markers to diagnose recurrence of disease (9). Patients with recurrent disease may then undergo a second CRS (hereafter, re-do CRS). However, recurrence is often difficult to detect by imaging and biochemistry alone as patients are often asymptomatic in the early stages of recurrence, and the sensitivity of CT scanning in detecting peritoneal recurrence approaches 60%, while also being influenced by factors such as size and extent of disease, location of spread, and radiologist expertise (10, 11). It has been established in the literature that the extent of peritoneal disease, as measured by the peritoneal cancer index (PCI), has a significant impact on the patient's prognosis, with a lower burden of peritoneal disease being associated with better CRS outcomes and improvements in morbidity (12). As earlier detection of disease is associated with a lower burden of peritoneal disease, better techniques should be devised to enable earlier 2350

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“…The PCI was assessed during laparotomy by dividing the abdomen and pelvis into 13 regions (0–12) and assigning a lesion size score (0–3) to each region [ 3 ]. The sum of all 13 individual lesion size scores, defined as total PCI, ranged from 0 to 39 [ 13 ].…”

Section: Methodsmentioning

confidence: 99%

“…The clinical presentation of PMP varies widely and depends on the disease course; however, due to its low incidence rate, the diagnosis is always challenging [ 2 ]. Cytoreductive surgery (CRS) in combination with hyperthermic intraperitoneal chemotherapy (HIPEC) is the active treatment for PMP [ 3 ]; since then, the prognosis of PMP patients has been greatly improved, with both progression-free survival ( PFS ) and overall survival ( OS ) being significantly prolonged.…”

Section: Introductionmentioning

confidence: 99%

Optimal peritoneal cancer index cutoff point for predicting surgical resectability of pseudomyxoma peritonei in treatment-naive patients

Bai,

Li,

et al. 2024

World J Surg Onc

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Background The peritoneal cancer index (PCI) has been used to predict surgical outcomes for pseudomyxoma peritonei (PMP). The present study aimed to establish the optimal cutoff point for PCI to predict surgical resectability of PMP. Methods A total of 366 PMP patients were included. The patients were divided into low-grade and high-grade groups. Based on the completeness of the cytoreduction (CC) score, both low-grade and high-grade PMP patients were further divided into complete cytoreductive surgery (CRS) and maximal tumor debulking (MTD) subgroups. The ability to predict surgical resectability of total and selected PCI (regions 2 + 9 to 12) was analyzed through receiver operating characteristic (ROC) curves. Results Both total and selected PCI demonstrated excellent discriminative ability in predicting surgical resectability for low-grade PMP patients (n = 266), with the ROC-AUC of 0.940 (95% CI: 0.904–0.965) and 0.927 (95% CI: 0.889–0.955). The corresponding optimal cutoff point was 21 and 5, respectively. For high-grade PMP patients (n = 100), both total and selected PCI exhibited good performance in predicting surgical resectability, with the ROC-AUC of 0.894 (95% CI: 0.816–0.946) and 0.888 (95% CI: 0.810–0.943); correspondingly, the optimal cutoff point was 25 and 8, respectively. The discriminative ability between total and selected PCI in predicting surgical resectability did not show a statistical difference. Conclusions Both total and selected PCI exhibited good performance and similarity in predicting complete surgical resection for both low-grade and high-grade PMP patients. However, the selected PCI was simpler and time-saving in clinical practice. In the future, new imaging techniques or predictive models may be developed to better predict PCI preoperatively, which might assist in confirming whether complete surgical resection can be achieved.

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Surgical management for peritoneal carcinomatosis of appendiceal origin with a high-tumor burden

Cited by 7 publications

References 33 publications

Scalloping of the Liver and Spleen on Preoperative CT-Scan of Pseudomyxoma Peritonei Patients: Impact on Prediction of Resectability, Grade, Morbidity and Survival

Scalloping of the Liver and Spleen on Preoperative CT-Scan of Pseudomyxoma Peritonei Patients: Impact on Prediction of Resectability, Grade, Morbidity and Survival

Second-look Surgery for Appendiceal High Grade and Colorectal Cancers Following Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

Optimal peritoneal cancer index cutoff point for predicting surgical resectability of pseudomyxoma peritonei in treatment-naive patients

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