title: Diagnostic accuracy of hand-assisted laparoscopy in predicting resectability of peritoneal carcinomatosis from gynecological malignancies.
abstract: OBJECTIVE
  Residual disease after excision surgery is the main prognostic factor in advanced ovarian cancer. Open surgery can delay neoadjuvant chemotherapy initiation. Therefore, a minimally invasive method for evaluating resectability would be of great interest. Aim of our study is to evaluate a new technique for assessing the extent of peritoneal carcinomatosis, combining manual palpation and standard laparoscopy.
  
  
  METHODS
  Prospective single-center study from October 2008 to January 2010. Patients with peritoneal carcinomatosis from gynecological malignancies were investigated by standard laparoscopy followed by laparoscopy plus manual palpation using Lapdisc(®) (Ethicon Inc.), at 43 abdominopelvic sites. When both techniques indicated resectability, standard cytoreduction surgery was performed via a midline laparotomy. The Fagotti, modified Fagotti, and Sugarbaker scores were computed. The diagnostic performance of each evaluation criterion was assessed by computing sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver-operating characteristic curves (ROC-AUCs).
  
  
  RESULTS
  Of the 29 included patients, 18 (62.1%) were considered to have resectable disease. Fourteen (14/18, 77.8%) had macroscopically complete cytoreduction. With Lapdisc(®), sensitivity was 100%, specificity 73.3%, PPV 77.8%, NPV 100%, and ROC-AUC 0.87. Corresponding values were as follows: laparoscopy, 100%, 40%, 60.9%, 100%, and 0.70; Fagotti and modified Fagotti scores, 100%, 46.7%, 63.6%, 100%, and 0.73; Sugarbaker score, 64.3%, 93.3%, 90%, 73.7%, and 0.79. The ROC-AUCs showed significantly better performance of Lapdisc(®) than of standard laparoscopy (P = 0.008).
  
  
  CONCLUSIONS
  Hand-assisted laparoscopy may perform better than laparoscopy alone for predicting the resectability of peritoneal carcinomatosis by increasing the number of sites evaluated.
authors.affiliation: Service de Chirurgie Cancérologique Gynécologique et du Sein, Hôpital Européen Georges-Pompidou, AP-HP, Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Varnoux
authors.forename: C
authors.initials: C
authors.lastname: Huchon
authors.forename: A S
authors.initials: AS
authors.lastname: Bats
authors.forename: C
authors.initials: C
authors.lastname: Bensaid
authors.forename: A
authors.initials: A
authors.lastname: Achouri
authors.forename: C
authors.initials: C
authors.lastname: Nos
authors.forename: F
authors.initials: F
authors.lastname: Lécuru
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D002277:Carcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D005833:Genital Neoplasms, Female / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D058733:Hand-Assisted Laparoscopy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008875:Middle Aged; D018365:Neoplasm, Residual / Q000175:diagnosis* / Q000601:surgery; D010051:Ovarian Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery; D010173:Palpation / Q000379:methods; D010534:Peritoneal Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D016896:Treatment Outcome