AIMS: The discovery of unexpected peritoneal carcinomatosis (PC) at the time of hepatectomy for colorectal liver metastases (CLM) is usually considered a contraindication for continuing resection. The first aim of this study was to assess the long-term outcome of patients operated for CLM, and who presented unexpected PC during laparotomy. The second aim was to identify preoperative predictors of PC. METHODS: All patients at a single center between 1985 and 2010 who had unexpected PC, discovered during planed resection of CLM, and negative preoperative imaging for PC were selected. Clinicopathological data were retrospectively analyzed to assess survival outcomes and to identify predictors of unexpected PC. RESULTS: Out of the 1340 operated patients for CLM, 42 (3%) had unexpected PC. Only patients (n = 30; 71%) who had PC limited to two abdominal regions (Median peritoneal cancer index (PCI): 2 (1-6)) were resected. Twelve patients were not resected due to the extent of peritoneal disease. The overall survival of the 30 patients resected for CLM who had limited PC was 18% at 5 years (median: 42 months). On multivariate analysis, a previous history of PC, a pT4 stage and bilobar CLM were independent predictors of unexpected PC. CONCLUSION: Unexpected PC should not be a contraindication for resection provided that the PCI is low and complete resection of all peritoneal and hepatic lesions can be achieved. Previous history of PC, a pT4 primary tumor and bilobar CLM are associated with increased risk of unexpected PC.
AIMS: The discovery of unexpected peritoneal carcinomatosis (PC) at the time of hepatectomy for colorectal liver metastases (CLM) is usually considered a contraindication for continuing resection. The first aim of this study was to assess the long-term outcome of patients operated for CLM, and who presented unexpected PC during laparotomy. The second aim was to identify preoperative predictors of PC. METHODS: All patients at a single center between 1985 and 2010 who had unexpected PC, discovered during planed resection of CLM, and negative preoperative imaging for PC were selected. Clinicopathological data were retrospectively analyzed to assess survival outcomes and to identify predictors of unexpected PC. RESULTS: Out of the 1340 operated patients for CLM, 42 (3%) had unexpected PC. Only patients (n = 30; 71%) who had PC limited to two abdominal regions (Median peritoneal cancer index (PCI): 2 (1-6)) were resected. Twelve patients were not resected due to the extent of peritoneal disease. The overall survival of the 30 patients resected for CLM who had limited PC was 18% at 5 years (median: 42 months). On multivariate analysis, a previous history of PC, a pT4 stage and bilobar CLM were independent predictors of unexpected PC. CONCLUSION: Unexpected PC should not be a contraindication for resection provided that the PCI is low and complete resection of all peritoneal and hepatic lesions can be achieved. Previous history of PC, a pT4 primary tumor and bilobar CLM are associated with increased risk of unexpected PC.
Authors: Reese W Randle; Andrea N Doud; Edward A Levine; Clancy J Clark; Katrina R Swett; Perry Shen; John H Stewart; Konstantinos I Votanopoulos Journal: Ann Surg Oncol Date: 2014-08-14 Impact factor: 5.344
Authors: William J Hadden; Philip R de Reuver; Kai Brown; Anubhav Mittal; Jaswinder S Samra; Thomas J Hugh Journal: HPB (Oxford) Date: 2016-02-01 Impact factor: 3.647
Authors: Orlando Jorge Martins Torres; Márcio Carmona Marques; Fabio Nasser Santos; Igor Correia de Farias; Anelisa Kruschewsky Coutinho; Cássio Virgílio Cavalcante de Oliveira; Antonio Nocchi Kalil; Celso Abdon Lopes de Mello; Jaime Arthur Pirola Kruger; Gustavo Dos Santos Fernandes; Claudemiro Quireze; André M Murad; Milton José de Barros E Silva; Charles Edouard Zurstrassen; Helano Carioca Freitas; Marcelo Rocha Cruz; Rui Weschenfelder; Marcelo Moura Linhares; Leonaldson Dos Santos Castro; Charles Vollmer; Elijah Dixon; Héber Salvador de Castro Ribeiro; Felipe José Fernandez Coimbra Journal: Arq Bras Cir Dig Date: 2016 Jul-Sep