title: Resectability of Peritoneal Carcinomatosis: Learnings from a Prospective Cohort of 533 Consecutive Patients Selected for Cytoreductive Surgery.
abstract: OBJECTIVE
  The aim of this study was to identify the risk factors and causes of unresectability in a large cohort of patients with peritoneal carcinomatosis (PC) selected for cytoreductive surgery (CRS), and to assess the contribution of the different imaging modalities to the patient-selection process.
  
  
  METHODS
  The pre- and intraoperative data of 533 consecutive patients with PC planned for CRS at a single institution were reviewed. All patients underwent computed tomography (CT) magnetic resonance imaging and/or positron emission tomography/CT within the 2 days prior to surgery.
  
  
  RESULTS
  Among the 533 patients, 436 (82 %) underwent complete CRS, 86 (16 %) underwent exploratory laparotomy without CRS because of multiple small-bowel involvement (n = 31), invasion of different digestive segments (n = 15), an elevated PC index (n = 14), invasion of the mesenteric root (n = 12), or another cause (n = 14), and 11 (2 %) did not undergo laparotomy because of disease progression on preoperative imaging findings. On univariate analysis, elevated levels of tumor markers and a short delay between the last cycle of chemotherapy and the scheduled surgery were identified as predictors of unresectability for the colonic PC population, while a younger age was identified in patients with gastric PC. Multivariate analysis disclosed the use of neoadjuvant chemotherapy and a younger age as independent predictors of unresectability in the colonic PC population.
  
  
  CONCLUSIONS
  The current modalities for the assessment of PC resectability, including functional imaging examinations, have a low impact on patient selection for CRS. New tools are needed to decrease the rate of open-close procedures.
authors.affiliation: Department of Digestive and Oncologic Surgery, Hospices Civils de Lyon, Centre Hospitalier Universitaire Lyon-Sud, Pierre-Bénite, France.|Equipe Mixte de Recherche 3738, Ecole Doctorale EDISS 205, Université Claude Bernard Lyon 1, Lyon, France.
authors.forename: Kayvan
authors.initials: K
authors.lastname: Mohkam
authors.affiliation: Department of Digestive and Oncologic Surgery, Hospices Civils de Lyon, Centre Hospitalier Universitaire Lyon-Sud, Pierre-Bénite, France.|Equipe Mixte de Recherche 3738, Ecole Doctorale EDISS 205, Université Claude Bernard Lyon 1, Lyon, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Passot
authors.affiliation: Department of Digestive and Oncologic Surgery, Hospices Civils de Lyon, Centre Hospitalier Universitaire Lyon-Sud, Pierre-Bénite, France.|Equipe Mixte de Recherche 3738, Ecole Doctorale EDISS 205, Université Claude Bernard Lyon 1, Lyon, France.
authors.forename: Eddy
authors.initials: E
authors.lastname: Cotte
authors.affiliation: Department of Digestive and Oncologic Surgery, Hospices Civils de Lyon, Centre Hospitalier Universitaire Lyon-Sud, Pierre-Bénite, France.|Equipe Mixte de Recherche 3738, Ecole Doctorale EDISS 205, Université Claude Bernard Lyon 1, Lyon, France.
authors.forename: Naoual
authors.initials: N
authors.lastname: Bakrin
authors.affiliation: Department of Digestive and Oncologic Surgery, Hospices Civils de Lyon, Centre Hospitalier Universitaire Lyon-Sud, Pierre-Bénite, France.|Equipe Mixte de Recherche 3738, Ecole Doctorale EDISS 205, Université Claude Bernard Lyon 1, Lyon, France.
authors.forename: François-Noël
authors.initials: FN
authors.lastname: Gilly
authors.affiliation: Intensive Care Unit, Hospices Civils de Lyon, Centre Hospitalier Universitaire Lyon-Sud, Pierre-Bénite, France.
authors.forename: Stanislas
authors.initials: S
authors.lastname: Ledochowski
authors.affiliation: Clinical Research Unit, Hospices Civils de Lyon, Pôle IMER, Lyon, France.
authors.forename: Lorraine
authors.initials: L
authors.lastname: Bernard
authors.affiliation: Equipe Mixte de Recherche 3738, Ecole Doctorale EDISS 205, Université Claude Bernard Lyon 1, Lyon, France.|Department of Radiology, Hospices Civils de Lyon, Centre Hospitalier Universitaire Lyon-Sud, Pierre-Bénite, France.
authors.forename: Pierre-Jean
authors.initials: PJ
authors.lastname: Valette
authors.affiliation: Department of Digestive and Oncologic Surgery, Hospices Civils de Lyon, Centre Hospitalier Universitaire Lyon-Sud, Pierre-Bénite, France. olivier.glehen@chu-lyon.fr.|Equipe Mixte de Recherche 3738, Ecole Doctorale EDISS 205, Université Claude Bernard Lyon 1, Lyon, France. olivier.glehen@chu-lyon.fr.
authors.forename: Olivier
authors.initials: O
authors.lastname: Glehen
authors.affiliation: Equipe Mixte de Recherche 3738, Ecole Doctorale EDISS 205, Université Claude Bernard Lyon 1, Lyon, France.|Department of Radiology, Hospices Civils de Lyon, Centre Hospitalier Universitaire Lyon-Sud, Pierre-Bénite, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Rousset
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D065426:Cytoreduction Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010534:Peritoneal Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary / Q000601:surgery*; D049268:Positron-Emission Tomography / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D015996:Survival Rate; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult