Aditi Bhatt1, Yutaka Yonemura2, Sanket Mehta3, Nazim Benzerdjeb4, Praveen Kammar3, Loma Parikh5, Mita Y Shah6, Sakina Shaikh1, Aruna Prabhu7, Suniti Mishra8, Snita Sinukumar9, Vahan Kepenekian10, Naoual Bakrin10, Guillaume Passot10, Olivier Glehen11. 1. Dept. of Surgical Oncology, Zydus hospital, Ahmedabad, India. 2. Peritoneal Metastases Center, Kishiwada Tokushukai Hospital, Osaka, Japan. 3. Dept. of Surgical Oncology, Saifee hospital, Mumbai, India. 4. Dept. of Pathology, Centre Hospitalier Lyon-sud, Lyon, France. 5. Dept. of Pathology, Zydus hospital, Ahmedabad, India. 6. Dept. of Pathology, Saifee hospital, Mumbai, India. 7. Dept. of Surgical Oncology, Thangam Cancer Centre, Nammakkal, India. 8. Dept. of Pathology, Fortis Hospital, Bangalore, India. 9. Dept. of Surgical Oncology, Jehangir hospital, Pune, India. 10. Dept. of Surgical Oncology, Centre Hospitalier Lyon-sud, Lyon, France. 11. Dept. of Surgical Oncology, Centre Hospitalier Lyon-sud, Lyon, France. Electronic address: olivier.glehen@chu-lyon.fr.
Abstract
BACKGROUND: The aim was to study the patterns of target region (greater omentum, lesser omentum, falciform and umbilical round ligament) involvement in patients undergoing cytoreductive surgery (CRS) from various primary tumors, factors affecting involvement and implications on surgical practice. METHODS: All patients undergoing CRS from July 2018 to December 2018 were included in this prospective study. The incidence of target region involvement in presence and absence of visible disease and the impact of primary tumor site, PCI and other variables on target region involvement was evaluated. RESULTS: In 191 patients, greater omentum was involved in over 15% of patients irrespective of the primary tumor type and in 15.7% in absence of visible disease. 75% of these had PCI <20. The involvement of the other three target regions was higher than 20% in ovarian cancer, appendiceal tumors and peritoneal mesothelioma. Involvement of these 3 regions was associated with a higher PCI (p < 0.001 for all) and omental involvement (p < 0.001for all). 2.1% of colorectal cancer patients had umbilical round ligament involvement, 4.2% had falciform ligament involvement and none had lesser omentum involvement. CONCLUSIONS: Target region involvement varies according to primary tumour site and disease extent. Resection of the greater omentum should be performed during CRS for PM arising from all primary sites. Resection of other target organs may be performed for selected patients with ovarian cancer, peritoneal mesothelioma and mucinous appendiceal tumors in absence of visible disease. For other patients, it should be done only in presence of visible disease.
BACKGROUND: The aim was to study the patterns of target region (greater omentum, lesser omentum, falciform and umbilical round ligament) involvement in patients undergoing cytoreductive surgery (CRS) from various primary tumors, factors affecting involvement and implications on surgical practice. METHODS: All patients undergoing CRS from July 2018 to December 2018 were included in this prospective study. The incidence of target region involvement in presence and absence of visible disease and the impact of primary tumor site, PCI and other variables on target region involvement was evaluated. RESULTS: In 191 patients, greater omentum was involved in over 15% of patients irrespective of the primary tumor type and in 15.7% in absence of visible disease. 75% of these had PCI <20. The involvement of the other three target regions was higher than 20% in ovarian cancer, appendiceal tumors and peritoneal mesothelioma. Involvement of these 3 regions was associated with a higher PCI (p < 0.001 for all) and omental involvement (p < 0.001for all). 2.1% of colorectal cancerpatients had umbilical round ligament involvement, 4.2% had falciform ligament involvement and none had lesser omentum involvement. CONCLUSIONS: Target region involvement varies according to primary tumour site and disease extent. Resection of the greater omentum should be performed during CRS for PM arising from all primary sites. Resection of other target organs may be performed for selected patients with ovarian cancer, peritoneal mesothelioma and mucinous appendiceal tumors in absence of visible disease. For other patients, it should be done only in presence of visible disease.