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No Indication for Routine Resection of Surgical Scars during Cytoreductive Surgery and HIPEC
Malin Enblad1, Lana Ghanipour1, Peter Cashin1
1Department of Surgical Sciences, Colorectal Surgery, Uppsala University, 751 85 Uppsala, Sweden.
Background:
Careful macroscopic assessment of surgical scars is needed to avoid routine scar resection during cytoreductive surgery (CRS) for peritoneal metastases (PM). This study aimed to analyze the correlation between macroscopically suspected and microscopically confirmed scar metastases (SMs), and to analyze the prognostic impact of not undergoing routine scar resection.
Method:
All patients with previous surgery, treated with CRS and hyperthermic intraperitoneal chemotherapy, for colorectal PM or pseudomyxoma peritonei (PMP), at Uppsala University Hospital in 2013-2021, were included. Macroscopic SMs in surgical reports were compared with histopathological analyses.
Results:
In total, 227 patients were included. Among colorectal PM patients (n = 156), SM was macroscopically suspected in 41 (26%) patients, and 63 (40%) underwent scar resection. SM was confirmed in 19 (30%). Among patients with macroscopic suspicion, 45% had confirmed SM (positive predictive value, PPV). A total of 1 of 23 (4%) patients with no macroscopic suspicion had SM (negative predictive value, NPV = 96%). Among the PMP patients (n = 71), SM was macroscopically suspected in 13 (18%), and 28 (39%) underwent scar resection, of whom 12 (43%) had SM. The PPV was 77%. Occult SM was found in 1 of 14 (NPV = 93%). Not undergoing routine scar resection did not affect recurrence-free survival (RFS, p = 0.2) or overall survival (OS, p = 0.1) in colorectal PM patients or PMP patients (RFS p = 0.7, OS p = 0.7).
Conclusion:
Occult SM is uncommon and scar resection does not affect RFS or OS. Therefore, macroscopically benign-appearing scars can be left without resection, though resection should be performed upon suspicion or uncertainty.
Insights
Routine scar resection is unnecessary for peritoneal metastases (PM) and pseudomyxoma peritonei (PMP) patients. Macroscopically benign scars can be safely left unresected, improving surgical efficiency without impacting patient survival.
Area of Science:
- Oncology
- Surgical Oncology
- Gastroenterology
Background:
- Cytoreductive surgery (CRS) for peritoneal metastases (PM) requires careful macroscopic assessment to prevent unnecessary scar resection.
- Identifying scar metastases (SMs) is crucial for appropriate surgical planning.
Purpose of the Study:
- To evaluate the correlation between macroscopic scar appearance and microscopic confirmation of scar metastases.
- To determine the prognostic impact of omitting routine scar resection in patients undergoing CRS.
Main Methods:
- Retrospective analysis of 227 patients with colorectal PM or PMP treated with CRS and hyperthermic intraperitoneal chemotherapy (2013-2021).
- Comparison of macroscopic scar findings in surgical reports with histopathological analyses.
- Assessment of recurrence-free survival (RFS) and overall survival (OS) in relation to scar resection status.
Main Results:
- In colorectal PM patients, macroscopic suspicion of SM had a positive predictive value (PPV) of 45%, while negative predictive value (NPV) was 96%.
- In PMP patients, PPV for SM was 77%, and NPV was 93%.
- Not performing routine scar resection did not significantly impact RFS or OS in either patient group.
Conclusions:
- Occult scar metastases are infrequent, suggesting routine resection is often unwarranted.
- Macroscopically benign scars can be safely preserved, optimizing surgical procedures.
- Resection of scars should be reserved for cases with macroscopic suspicion or uncertainty regarding metastases.
