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Peritoneal Surface Malignancies

E360: Perihepatic tumor burden in pseudomyxoma peritonei predicts complexity of cytoreductive surgery and risk of recurrence but not resectability or survival

    ePoster Abstract Author(s)

  • Steven Ahrendt, MD

    Professor
    University of Colroado
    Aurora, Colorado, United States

    • Submitter(s)

  • Steven Ahrendt, MD

    Professor
    University of Colroado
    Aurora, Colorado, United States

    • Author(s)

  • BM

    Benedetto Mungo, MD

    Assistant Professor of Surgery
    University of Colorado, Department of Surgery, United States

  • Robert J. Torphy, MD

    Srgical Oncology Fellow
    University of Colorado
    Aurora, Colorado, United States

  • MM

    Matthew Markese, MD

    Assistant Professor
    University of Colorado
    Aurora, Colorado, United States

Introduction:

Cytoreductive surgery (CRS) is the only effective treatment option for patients with pseudomyxoma peritonei (PMP). The extent of perihepatic disease on cross-sectional imaging has been proposed as a method for predicting resectability in patients with PMP. The purpose of this study is to determine whether PMP patients with a high perihepatic disease burden benefit from extensive CRS.

Methods:  Patients with PMP undergoing an initial attempt at CRS/HIPEC were identified from our prospective database.  The preoperative CT scan from each patient was reviewed independently by two surgical oncologists and one radiologist and a radiologic score (RS) was calculated based on the perihepatic disease burden on preoperative CT scan (Bouquot et al, Ann Surg Oncol, 2017). A sum of tumor measurements in 5 perihepatic sites (RS) greater than 28 mm predicted unresectability in this study. We examined the ability of RS to predict resectability and survival of patients with PMP at our institution.

Results: Between 2017 and the present, 105 patients underwent an initial planned CRS for PMP. Seven patients underwent laparotomy only, 3 patients underwent only the first of a planned two stage procedure. CRS was completed in 95 patients (Table 1). The vast majority (95%) of patients with RS< 28 underwent complete or near complete CRS. However, two-thirds (66%) of patients with RS >28 also underwent CC0 or CC1 resections. The rate of nontherapeutic laparotomy was not significantly different among groups. RS >28 did accurately predict the complexity of the procedure with significantly higher blood loss, operative time, and GI anastomoses. Progression-free (PFS) was decreased in patients with RS >28 (p< 0.001; median PFS 11.2 months vs not-reached). However, overall survival (OS) was similar (p=0.92) between the two groups with 3-year and 5-year OS of 64% and 64% (RS< 28) and 86% and 62% (RS >28).

Conclusions:

Many patients with extensive perihepatic tumor burden can undergo successful CRS with prolonged overall survival. These procedures are long, complex, and the recurrence risk is high.

Learning Objectives:

  • to discuss the use of RS in predicting resectability in patients with PMP
  • to discuss the ability of RS to predict survival in patients with PMP undergoing CRS
  • to define the role of RS in predicting operative complexity in patients with PMP undergoing CRS