Proposed radiological criteria for pre-operative determination of resectability in peritoneal-based malignancies.
BACKGROUND
The selection of patients for cytoreductive surgery (CRS) and hyperthermic intra-peritoneal chemotherapy infusion (HIPEC) is important, and relies heavily on imaging. However, it has been reported that Computer Tomographic (CT) scans may only achieve a low sensitivity of 33% for peritoneal disease. We propose a set of radiological criteria for pre-operative determination of resectability of peritoneal disease in peritoneal-based malignancies and validate this in our cohort of patients.


METHODS
A retrospective review of all patients who underwent laparotomy with a view for CRS and HIPEC, at the National Cancer Centre Singapore from January 2000 to April 2010, was performed. Intra-operative Peritoneal Cancer Index (PCI) scores were recorded. The pre-operative imaging was reviewed with a senior radiologist who was blinded, and recorded the radiological PCI scores (CT-PCI) and eight additional CT prognostic factors (CT-PF). The CT-PCI and CT-PF scores were then compared with the intra-operative findings to determine the radiological accuracy. The scores and the individual prognostic factors were then evaluated for their predictive ability for unresectability.


RESULTS
Comparison of the CT-PCI and PCI scores showed a concordance correlation coefficient at 0.52 (95% CI 0.34-0.7). Accuracy was increased with the addition CT-PF. The presence of omental caking and ascites were predictors of unresectability. We propose a scoring system which is able to predict for unresectable disease with a specificity of 80% and a sensitivity of 62%.


CONCLUSIONS
With our proposed criteria, and scoring system, the selection of patients for CRS and HIPEC can be improved, and unnecessary exploratory operations avoided.
Department of Surgical Oncology, National Cancer Centre Singapore, Singapore.
Grace Hwei Ching
GH
Tan
Division of Oncologic Imaging, National Cancer Centre Singapore, Singapore.
Jin Wei
JW
Kwek
IBM Research Collaboratory, Singapore.
Reza
R
Hosseini
Department of Surgical Oncology, National Cancer Centre Singapore, Singapore.
Jendana
J
Chanyaputhipong
Department of Medical Oncology, National Cancer Centre Singapore, Singapore.
Chee Kian
CK
Tham
National Cancer Centre Singapore, Singapore.
Khee Chee
KC
Soo
Department of Surgical Oncology, National Cancer Centre Singapore, Singapore.
Melissa Ching Ching
MC
Teo
D015331:Cohort Studies; D006801:Humans; D006979:Hyperthermia, Induced; D010534:Peritoneal Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D057234:Preoperative Period; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012846:Singapore; D014057:Tomography, X-Ray Computed
cytoreductive surgery; hyperthermic intra-peritoneal chemotherapy; radiological criteria; resectability