Preoperative computed tomography does not predict resectability in peritoneal carcinomatosis.

Area of Science:

• Oncology
• Radiology
• Surgical Oncology

Background:

• Complete cytoreduction is crucial for long-term survival in patients with peritoneal carcinomatosis (PC).
• Accurate prediction of unresectability preoperatively is essential for surgical planning.
• Computed tomography (CT) is a key imaging modality in evaluating PC.

Purpose of the Study:

• To identify preoperative CT features that predict unresectability in patients with PC.
• To correlate imaging findings with intraoperative findings and outcomes.
• To improve the selection of patients for cytoreductive surgery.

Main Methods:

• Retrospective case-control study comparing 15 unresectable PC patients with 15 completely resected PC patients.
• Patients were matched by intraoperative Peritoneal Cancer Index (PCI) and pathology.
• Abdominopelvic CT scans were blindly reviewed by two surgical oncologists.

Main Results:

• Preoperative imaging-based PCI did not differ significantly between resectable and unresectable groups (P = .851).
• Imaging-based PCI significantly underestimated the intraoperative PCI (P = .003).
• While no single feature predicted unresectability, the presence of two or more concerning features was associated with a higher likelihood of unresectability (87.5% vs 36.4%, P = .035).

Conclusions:

• The presence of two or more concerning features on preoperative CT scans is linked to an increased risk of unresectability in PC patients.
• No single CT imaging feature should preclude a patient from undergoing an attempted cytoreduction.
• Preoperative CT can aid in risk stratification, but surgical exploration may still be warranted.