Association between preoperative appendiceal histology grade and Pseudomyxoma peritonei grade offers a solution to
Richard Ghandour1, Armelle Bardier2, Mathilde Wagner3
1Department of Hepato-Biliary and Pancreatic Surgery, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière University Hospital, 47-83 Bd de l'Hôpital,Cedex 13, F-75651, Paris, France.
Introduction & Objectives:
Treatment of PMP consists of appendectomy, cytoreductive surgery (CRS) and HIPEC. Right-sided hemicolectomy is necessary only when PMP is high grade, given the lymphatic invasion risk. To date, no single preoperative factor was identified as predictive of PMP grade.
Materials & Methods:
Preoperative factors of a prospective cohort study on PMP were retrospectively analyzed, in order to identify situations linked with high or low grade appendiceal PMP. The main outcome was PMP grade on definitive histology after CRS.
Results:
n = 105. In univariate analysis, the grade of the appendiceal tumor, systematically reviewed in an expert center, showed an OR of 25.00 (95 % CI: 3.30-189.27; p = 0.001) and an NPV of 93.75 [85.36, 100]. Peritoneal biopsy demonstrated an OR of 19.80 (95 % CI: 2.30-170.71; p = 0.002) and a PPV of 90 [71.41, 100]. In multivariate analysis, these two factors remained significantly associated with PMP grade.
Conclusion:
Whenever appendiceal tumor is low grade on preoperative histology, the colon has to be spared unless completeness of CRS is compromised, which is a high-grade feature in fact. In case of high grade appendiceal tumor and/or peritoneal biopsy, right-sided hemicolectomy is warranted. If no histology is available preoperatively, adapt to intraoperative lesions as no preoperative factors seem to be predictive.
Insights
Preoperative histology of appendiceal tumors and peritoneal biopsies can predict the grade of pseudomyxoma peritonei (PMP). This helps determine if a right-sided hemicolectomy is necessary during cytoreductive surgery (CRS) and HIPEC.
Area of Science:
- Oncology
- Surgical Oncology
- Gastroenterology
Background:
- Pseudomyxoma peritonei (PMP) treatment involves appendectomy, cytoreductive surgery (CRS), and hyperthermic intraperitoneal chemotherapy (HIPEC).
- Right-sided hemicolectomy is reserved for high-grade PMP due to lymphatic invasion risk.
- Predictive preoperative factors for PMP grade are currently lacking.
Purpose of the Study:
- To identify preoperative factors that predict the grade of appendiceal PMP.
- To guide surgical decisions regarding right-sided hemicolectomy in PMP patients.
Main Methods:
- Retrospective analysis of preoperative factors from a prospective cohort study on PMP.
- Evaluation of appendiceal tumor grade and peritoneal biopsy results.
- Correlation of preoperative findings with definitive PMP grade post-CRS.
Main Results:
- Appendiceal tumor grade (OR 25.00) and peritoneal biopsy (OR 19.80) were significantly associated with PMP grade in multivariate analysis.
- High-grade appendiceal tumors and positive peritoneal biopsies predicted high-grade PMP.
- Negative predictive value for low-grade appendiceal tumor was 93.75%.
Conclusions:
- Low-grade appendiceal tumor on preoperative histology suggests sparing the colon, unless CRS completeness is compromised.
- High-grade appendiceal tumor and/or positive peritoneal biopsy warrant a right-sided hemicolectomy.
- In the absence of preoperative histology, intraoperative findings should guide surgical decisions.
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