Is unexpected peritoneal carcinomatosis still a contraindication for resection of colorectal liver metastases? Combined resection of colorectal liver metastases with peritoneal deposits discovered intra-operatively.
AIMS
The discovery of unexpected peritoneal carcinomatosis (PC) at the time of hepatectomy for colorectal liver metastases (CLM) is usually considered a contraindication for continuing resection. The first aim of this study was to assess the long-term outcome of patients operated for CLM, and who presented unexpected PC during laparotomy. The second aim was to identify preoperative predictors of PC.


METHODS
All patients at a single center between 1985 and 2010 who had unexpected PC, discovered during planed resection of CLM, and negative preoperative imaging for PC were selected. Clinicopathological data were retrospectively analyzed to assess survival outcomes and to identify predictors of unexpected PC.


RESULTS
Out of the 1340 operated patients for CLM, 42 (3%) had unexpected PC. Only patients (n = 30; 71%) who had PC limited to two abdominal regions (Median peritoneal cancer index (PCI): 2 (1-6)) were resected. Twelve patients were not resected due to the extent of peritoneal disease. The overall survival of the 30 patients resected for CLM who had limited PC was 18% at 5 years (median: 42 months). On multivariate analysis, a previous history of PC, a pT4 stage and bilobar CLM were independent predictors of unexpected PC.


CONCLUSION
Unexpected PC should not be a contraindication for resection provided that the PCI is low and complete resection of all peritoneal and hepatic lesions can be achieved. Previous history of PC, a pT4 primary tumor and bilobar CLM are associated with increased risk of unexpected PC.
['Allard|M A|MA|', 'Adam|R|R|', 'Ruiz|A|A|', 'Vibert|E|E|', 'Paule|B|B|', 'Levi|F|F|', 'Sebagh|M|M|', 'Guettier|C|C|', 'Azoulay|D|D|', 'Castaing|D|D|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D002277:Carcinoma D015331:Cohort Studies D015179:Colorectal Neoplasms D000075202:Contraindications D005260:Female D006498:Hepatectomy D006801:Humans D008113:Liver Neoplasms D008137:Longitudinal Studies D008297:Male D008875:Middle Aged D010534:Peritoneal Neoplasms D011379:Prognosis D012189:Retrospective Studies D016896:Treatment Outcome
Unexpected peritoneal carcinomatosis peritoneal carcinomatosis Colorectal liver metastases Colorectal liver metastases PC CLM peritoneal cancer index PCI CS FDG HIPEC PET colorectal liver metastases cytoreductive surgery fluorodeoxyglucose hyperthermic intraperitoneal chemotherapy positron emission tomography