Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
Department of Surgical Oncology, Catharina Cancer Institute, Eindhoven, The Netherlands.
Acta Radiol. 2024 Jun;65(6):525-534. doi: 10.1177/02841851241229154. Epub 2024 Mar 4.
Despite thorough preoperative work-up for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC), so called open-close (OC) procedures as a result of irresectable disease remain common. Currently, diagnostic laparoscopy (DLS) is considered the gold standard, and consequently overrules the results of computed tomography (CT) scans; however, certain regions of the abdomen are difficult to assess and postoperative adhesion formation may further compromise staging during DLS.
To determine whether better clinical assessment could be achieved by combining the results of DLS and preoperative CT scans during a multidisciplinary team (MDT) meeting.
All patients who were eligible for CRS-HIPEC after DLS, but eventually underwent an OC procedure between 2010 and 2018 were selected. Radiological reassessment of CT scans was performed and combined with assessment of the DLS during a MDT meeting. The MDT was blinded for the outcome of the procedure (OC vs. CRS-HIPEC).
The majority of the OC procedures (69%) was correctly predicted by the MDT. In most patients (88%), this conclusion was based on the combination of the radiological and surgical peritoneal cancer index (PCI). CT was particularly accurate for detection of larger tumor deposits in the abdominal regions, as 84%-86% was detected. Assessment of lesions in the small bowel regions is troublesome; 72% of lesions are missed on the preoperative CT scan.
A combination of radiological and surgical assessment of the PCI may lead to improved preoperative patient selection for CRS-HIPEC.
尽管在细胞减灭术和腹腔热灌注化疗（CRS-HIPEC）前进行了彻底的术前检查，但由于无法切除的疾病，仍然经常进行所谓的开闭式（OC）手术。目前，诊断腹腔镜检查（DLS）被认为是金标准，因此推翻了计算机断层扫描（CT）扫描的结果；然而，腹部的某些区域难以评估，并且 DLS 期间术后粘连形成可能进一步影响分期。
确定在多学科团队（MDT）会议上通过结合 DLS 和术前 CT 扫描的结果是否可以获得更好的临床评估。
选择所有在 DLS 后有资格接受 CRS-HIPEC 但最终在 2010 年至 2018 年间进行 OC 手术的患者。对 CT 扫描进行放射学重新评估，并在 MDT 会议期间结合 DLS 的评估。MDT 对手术结果（OC 与 CRS-HIPEC）进行盲法评估。
MDT 正确预测了大多数 OC 手术（69%）。在大多数患者（88%）中，这一结论基于放射学和手术腹膜癌指数（PCI）的结合。CT 特别擅长检测腹部较大的肿瘤沉积物，因为可以检测到 84%-86%的沉积物。评估小肠区域的病变很麻烦；术前 CT 扫描漏诊 72%的病变。
PCI 的放射学和手术评估相结合可能会改善 CRS-HIPEC 的术前患者选择。
