Determining the Association Between Preoperative Computed Tomography Findings and Postoperative Outcomes After Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy for Pseudomyxoma Peritonei

• Published in: Annals of surgical oncology 2011-06, Vol.18 (6), p.1582-1589
• Main Authors: Chua, Terence C., Al-Zahrani, Abdulaziz, Saxena, Akshat, Glenn, Derek, Liauw, Winston, Zhao, Jing, Morris, David L.
• Format: Article
• Language: English
• Subjects: Adenocarcinoma, Mucinous - diagnostic imaging; Adenocarcinoma, Mucinous - surgery; Adenocarcinoma, Mucinous - therapy; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Appendiceal Neoplasms - diagnostic imaging; Appendiceal Neoplasms - surgery; Appendiceal Neoplasms - therapy; Chemotherapy, Adjuvant; Combined Modality Therapy; Female; Gastrointestinal Oncology; Humans; Injections, Intraperitoneal; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Staging; Oncology; Perioperative Care; Peritoneal Neoplasms - diagnostic imaging; Peritoneal Neoplasms - surgery; Peritoneal Neoplasms - therapy; Postoperative Complications; Preoperative Care; Pseudomyxoma Peritonei - diagnostic imaging; Pseudomyxoma Peritonei - surgery; Pseudomyxoma Peritonei - therapy; Surgery; Surgical Oncology; Survival Rate; Tomography, X-Ray Computed; Treatment Outcome
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-010-1492-3

Background This study evaluates the accuracy of computed tomography (CT) scoring of the peritoneal cancer index (PCI) and examines its association with surgical morbidity and outcomes in pseudomyxoma peritonei. Methods Forty-seven patients with pseudomyxoma peritonei had preoperative evaluation of CT scans and were treated with cytoreductive surgery and perioperative intraperitoneal chemotherapy. Their radiological PCI and intraoperative PCI were scored for determination of accuracy and for correlation with morbidity and outcomes. Results Accuracy in detecting peritoneal lesions regardless of size ranged from 51% to 85% in the abdominopelvic regions and 21% to 25% in the small intestinal regions. The sensitivity of CT detection of peritoneal implants ranged from 67% to 84% in the abdominopelvic regions and from 56% to 57% in the small intestinal regions. The specificity of CT detection of peritoneal lesions was 100% in all regions. Preoperative CT identification of larger peritoneal lesions in the right upper quadrant ( P  = 0.016), epigastrium ( P  = 0.003), left upper quadrant ( P  = 0.019), proximal jejunum ( P  = 0.022), distal jejunum ( P  = 0.022), and proximal ileum ( P  = 0.022) predicted development of severe complications. Similarly, larger peritoneal lesions in the right upper quadrant ( P  = 0.039), epigastrium ( P  = 0.024), right flank ( P  = 0.005), and right lower quadrant ( P  = 0.034) were negatively associated with disease-free survival, and the right upper quadrant ( P  = 0.037) was negatively associated with overall survival. Conclusions Preoperative CT scan depicting extensive upper abdominal and small bowel disease predicts the presence of severe complications after cytoreduction. Extensive disease in the right upper quadrant seems to be associated with a poorer survival outcome.