Peritoneal metastases found in routinely resected specimens after cytoreductive surgery and heated intraperitoneal chemotherapy

Jesper Nors,Lene Hjerrild Iversen,Karsten Nielsen,Mette Møller Sørensen,Victor Jilbert Verwaal,Jonas Amstrup Funder

doi:10.1016/j.ejso.2021.12.026

Jesper Nors, Lene Hjerrild Iversen + Show 4 more

Open Access

https://doi.org/10.1016/j.ejso.2021.12.026

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Abstract

IntroductionPeritoneal metastases (PM) originating from colorectal cancer (CRC) and pseudomyxoma peritonei (PMP) can be treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Certain sites in the peritoneal cavity are prone to contain PM and are, therefore, routinely resected. The aim of this study is to investigate the frequency of disease in CRS specimens routinely resected. Secondly, to investigate if the risk of finding PM in routinely resected specimen is associated with involvement of anatomic related peritoneal areas. Materials and methodsThis study investigated 433 patients diagnosed with PMP (n = 119) or PM from CRC (n = 314) and operated with CRS + HIPEC between June 2006 and November 2020 at a national center. Baseline data were prospectively registered. Pathology reports were reviewed for the presence of metastases in the routinely resected umbilicus, ligamentum teres hepatis, ovaries and greater omentum. Tumor extent was estimated using the Dutch region count. ResultsPM was found in 14.7% of umbilical resections, in 17.4% of the resected ligamentum teres hepatis, in 48.2% of the resected ovaries and in 49.5% of the greater omentum specimens. We found an association between macroscopic disease involvement of the nearest region and risk of PM found in the related resections. Seven of 31 women with no macroscopically visible disease in the pelvis had PM diagnosed in the resected ovaries. ConclusionsA substantial proportion of routine resections held histologic verified PM. Our results may advocate for a routinely performed resection of the umbilicus, ligamentum teres hepatis, ovaries and greater omentum.

Highlights

Peritoneal metastases (PM) originating from colorectal cancer (CRC) and pseudomyxoma peritonei (PMP) can be treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC)
Patients diagnosed with pseudomyxoma peritonei (PMP) or PM originating from colorectal cancer (CRC) and operated with CRS and HIPEC at the single national center at the Aarhus University Hospital, Denmark, from June 2006 to November 2020, were included in the study
One hundred and nineteen (27.5%) patients were diagnosed with PMP and 314 (72.5%) patients were diagnosed with synchronous or metachronous PM from CRC

Summary

Introduction

Peritoneal metastases (PM) originating from colorectal cancer (CRC) and pseudomyxoma peritonei (PMP) can be treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Pathology reports were reviewed for the presence of metastases in the routinely resected umbilicus, ligamentum teres hepatis, ovaries and greater omentum. Our results may advocate for a routinely performed resection of the umbilicus, ligamentum teres hepatis, ovaries and greater omentum. Peritoneal metastases (PM) can, if not too widespread, be treated with curative intent with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) [1e3]. A complete cytoreduction is the corner stone of curative treatment [4,5] This is achieved by resection of all macroscopically visible tumor involved parietal peritoneum and organs with tumor ingrowth [4,6]. Surgery in general leads to increased shedding of cancer cells into the circulation and induces inflammatory responses that contribute to an accelerated growth of residual and metastatic disease [13]

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