Aditi Bhatt1, Yutaka Yonemura2, Nazim Benzerdjeb3, Sanket Mehta4, Suniti Mishra5, Loma Parikh6, Praveen Kammar4, Mita Y Shah7, Aruna Prabhu8, Sakina Shaikh9, Mahesh D Patel9, Sylvie Isaac3, Olivier Glehen10. 1. Dept. of Surgical Oncology, Zydus Hospital, Ahmedabad, India. Electronic address: aditimodi31@gmail.com. 2. Peritoneal Metastases Center, Kishiwada Tokushukai Hospital, Osaka, Japan. 3. Dept. of Pathology, Centre Hospitalier Lyon-sud, Lyon, France. 4. Dept. of Surgical Oncology, Saifee Hospital, Mumbai, India. 5. Dept. of Pathology, Fortis Hospital, Bangalore, India. 6. Dept. of Pathology, Zydus Hospital, Ahmedabad, India. 7. Dept. of Pathology, Saifee Hospital, Mumbai, India. 8. Dept of Surgical Oncology, Thangam Cancer Centre, Nammakkal, India. 9. Dept. of Surgical Oncology, Zydus Hospital, Ahmedabad, India. 10. Dept. of Surgical Oncology, Centre Hospitalier Lyon-sud, Lyon, France.
Abstract
BACKGROUND AND AIM: The grade/histological subtype is one of the most important prognostic markers in patients undergoing cytoreductive surgery (CRS). Our aim was to study other potential prognostic information that can be derived from the pathological evaluation of CRS specimens and provide a broad outline for evaluation of these. METHODS: This prospective study (July to December 2018) included all patients undergoing cytoreductive surgery (CRS). A protocol for pathological evaluation was laid down which was based on existing practices at the participating centers and included evaluation of the pathological PCI, regional node involvement, response to chemotherapy, morphology of peritoneal metastases (PM) and distribution in the peritoneal cavity. RESULTS: In 191 patients undergoing CRS at 4 centers, the pathological and surgical PCI differed in over 75%. Nodes in relation to peritoneal disease were positive in 13.6%. Disease in normal peritoneum adjacent to tumor nodules was seen in >50% patients with ovarian cancer and mucinous apppendiceal tumors. 23.8% of evaluated colorectal PM patients had a complete response and 25.0% ovarian cancer patients had a near complete pathological response to chemotherapy. CONCLUSIONS: Pathological evaluation of extent and distribution of peritoneal disease differs from the surgical evaluation in majority of the patients. Lymph node involvement in relation of peritoneal disease is common. The morphological presentation of PM in ovarian cancer and mucinous appendiceal tumors merits evaluation of more extensive resections in these patients. Standardized methods of synoptic reporting of CRS specimens could help capture vital prognostic information that may in future influence how these patients are treated.
BACKGROUND AND AIM: The grade/histological subtype is one of the most important prognostic markers in patients undergoing cytoreductive surgery (CRS). Our aim was to study other potential prognostic information that can be derived from the pathological evaluation of CRS specimens and provide a broad outline for evaluation of these. METHODS: This prospective study (July to December 2018) included all patients undergoing cytoreductive surgery (CRS). A protocol for pathological evaluation was laid down which was based on existing practices at the participating centers and included evaluation of the pathological PCI, regional node involvement, response to chemotherapy, morphology of peritoneal metastases (PM) and distribution in the peritoneal cavity. RESULTS: In 191 patients undergoing CRS at 4 centers, the pathological and surgical PCI differed in over 75%. Nodes in relation to peritoneal disease were positive in 13.6%. Disease in normal peritoneum adjacent to tumor nodules was seen in >50% patients with ovarian cancer and mucinous apppendiceal tumors. 23.8% of evaluated colorectal PMpatients had a complete response and 25.0% ovarian cancerpatients had a near complete pathological response to chemotherapy. CONCLUSIONS: Pathological evaluation of extent and distribution of peritoneal disease differs from the surgical evaluation in majority of the patients. Lymph node involvement in relation of peritoneal disease is common. The morphological presentation of PM in ovarian cancer and mucinous appendiceal tumors merits evaluation of more extensive resections in these patients. Standardized methods of synoptic reporting of CRS specimens could help capture vital prognostic information that may in future influence how these patients are treated.