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Determining the Association Between Preoperative Computed Tomography Findings and Postoperative Outcomes After Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy for Pseudomyxoma Peritonei

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

This study evaluates the accuracy of computed tomography (CT) scoring of the peritoneal cancer index (PCI) and examines its association with surgical morbidity and outcomes in pseudomyxoma peritonei.

Methods

Forty-seven patients with pseudomyxoma peritonei had preoperative evaluation of CT scans and were treated with cytoreductive surgery and perioperative intraperitoneal chemotherapy. Their radiological PCI and intraoperative PCI were scored for determination of accuracy and for correlation with morbidity and outcomes.

Results

Accuracy in detecting peritoneal lesions regardless of size ranged from 51% to 85% in the abdominopelvic regions and 21% to 25% in the small intestinal regions. The sensitivity of CT detection of peritoneal implants ranged from 67% to 84% in the abdominopelvic regions and from 56% to 57% in the small intestinal regions. The specificity of CT detection of peritoneal lesions was 100% in all regions. Preoperative CT identification of larger peritoneal lesions in the right upper quadrant (P = 0.016), epigastrium (P = 0.003), left upper quadrant (P = 0.019), proximal jejunum (P = 0.022), distal jejunum (P = 0.022), and proximal ileum (P = 0.022) predicted development of severe complications. Similarly, larger peritoneal lesions in the right upper quadrant (P = 0.039), epigastrium (P = 0.024), right flank (P = 0.005), and right lower quadrant (P = 0.034) were negatively associated with disease-free survival, and the right upper quadrant (P = 0.037) was negatively associated with overall survival.

Conclusions

Preoperative CT scan depicting extensive upper abdominal and small bowel disease predicts the presence of severe complications after cytoreduction. Extensive disease in the right upper quadrant seems to be associated with a poorer survival outcome.

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Authors and Affiliations

  1. UNSW Department of Surgery, St. George Hospital, Kogarah, Sydney, NSW, Australia

    Terence C. Chua BScMed (Hons), MBBS, Abdulaziz Al-Zahrani MBBS, Akshat Saxena BMedSc, Jing Zhao MD & David L. Morris MD, PhD

  2. Department of Radiology, St. George Hospital, Kogarah, Sydney, NSW, Australia

    Derek Glenn MBBS, FRANZCR

  3. Department of Medical Oncology, St. George Hospital, Kogarah, Sydney, NSW, Australia

    Winston Liauw MBBS

Authors
  1. Terence C. Chua BScMed (Hons), MBBS
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  2. Abdulaziz Al-Zahrani MBBS
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  3. Akshat Saxena BMedSc
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  4. Derek Glenn MBBS, FRANZCR
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  5. Winston Liauw MBBS
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  6. Jing Zhao MD
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  7. David L. Morris MD, PhD
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Corresponding author

Correspondence to Terence C. Chua BScMed (Hons), MBBS.

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Chua, T.C., Al-Zahrani, A., Saxena, A. et al. Determining the Association Between Preoperative Computed Tomography Findings and Postoperative Outcomes After Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy for Pseudomyxoma Peritonei. Ann Surg Oncol 18, 1582–1589 (2011). https://doi.org/10.1245/s10434-010-1492-3

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  • DOI: https://doi.org/10.1245/s10434-010-1492-3

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