Multicentre study of laparoscopic or open assessment of the peritoneal cancer index (BIG-RENAPE)

Passot, Guillaume; Dumont, F; Goèré, Diane; Arvieux, C.; Rousset, Pascal; Régimbeau, Jean‐Marc; Élias, Dominique; Villeneuve, Laurent; Gléhen, Olivier; Abba, J.; Abboud, Karine; Carere, S; Durand-Fontanier, Sylvaine; Eveno, Clarisse; Facy, Olivier; Gelli, Maximiliano; Gilly, F. N.; Karoui, Mehdi; Dico, Réa Lo; Ortega-Deballon, P.; Pocard, Marc; Quénet, François; Rat, Patrick; Sabbagh, Charles; Sgarbură, Olivia; Thibaudeau, Emilie; Vaudoyer, Delphine; Wernert, Romuald

doi:10.1002/bjs.10723

Cited by 70 publications

(30 citation statements)

References 14 publications

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“…A limitation of this single‐centre study was that the reference standard was laparoscopy in one‐quarter of patients. Although clinical decision‐making is currently generally based on DLS, exploratory laparotomy might be a better reference standard as it has a lower risk of underestimating the PCI. Furthermore, the interval between surgery and MRI was generally shorter than that between surgery and CT.…”

Section: Discussionmentioning

confidence: 99%

Diffusion-weighted MRI assessment of the peritoneal cancer index before cytoreductive surgery

Sant

Eden

Engbersen

et al. 2018

British Journal of Surgery

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Background: Patients with limited peritoneal metastases from colorectal cancer may be candidates for an aggressive surgical approach including cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC). Selection is based on surgical inspection during laparoscopy or laparotomy. The aim of this study was to investigate whether diffusion-weighted MRI (DW-MRI) can be used to select patients for CRS-HIPEC.Methods: This was a prospective study at a tertiary referral centre. Patients with confirmed or suspected colorectal peritoneal metastases scheduled for exploratory laparotomy or laparoscopy were eligible. Two radiologists assessed the peritoneal cancer index (PCI) on CT (CT-PCI) and DW-MRI (MRI-PCI). The reference standard was PCI at surgery. Radiologists were blinded to the surgical PCI and to each other's findings. The main outcome was the accuracy of DW-MRI in predicting whether patients had resectable disease (PCI less than 21) or not.Results: Fifty-six patients were included in the study, of whom 49 could be evaluated. The mean(s.d.) PCI at surgery was 11⋅27(7⋅53). The mean MRI-PCI was 10⋅18(7⋅07) for reader 1 and 8⋅59(7⋅08) for reader 2. Readers 1 and 2 correctly staged 47 of 49 and 44 of 49 patients respectively (accuracy 96 and 90 per cent). Both readers detected all patients with resectable disease with a PCI below 21 at surgery (sensitivity 100 per cent). No patient was overstaged. The intraclass correlation (ICC) between readers was excellent (ICC 0⋅91, 95 per cent c.i. 0⋅77 to 0⋅96). MRI-PCI had a stronger correlation with surgical PCI (ICC 0⋅83-0⋅88) than did CT-PCI (ICC 0⋅39-0⋅44).Conclusion: DW-MRI is a promising non-invasive tool to guide treatment selection in patients with peritoneal metastases from colorectal cancer.

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Section: Discussionmentioning

confidence: 99%

Diffusion-weighted MRI assessment of the peritoneal cancer index before cytoreductive surgery

Sant

Eden

Engbersen

et al. 2018

British Journal of Surgery

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“…Laparoscopic exploration can assess the peritoneal cancer index (PCI) more accurately then preoperative radiological investigations [36]. Moreover, during laparoscopy, any potential cause of unresectability (mesenteric retraction or infiltration of the hepatic hilum, suprahepatic veins and Treitz ligament) can be easily identified under direct vision [37]. Therefore, it is crucial that laparoscopy should be performed by skilled surgeons in peritoneal surgery, it being is the most accurate staging tool in patients selected for surgery (statement 11).…”

Section: Discussionmentioning

confidence: 99%

Diagnostic and therapeutic algorithm for colorectal peritoneal metastases. A consensus of the peritoneal surface malignancies onco-team of the Italian society of surgical oncology

Sommariva

Ansaloni

Baiocchi

et al. 2021

European Journal of Surgical Oncology

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Aim: the surgical workup for colorectal cancer peritoneal metastases (CRCPM) is complex and should be managed in specialized centers. Diagnostic and therapeutic algorithms (DTA) have been proposed to balance optimal patients management and correct use of resources. Aim of this study was to establish a consensus on DTA for CRCPM patients in Italy. Method: a panel of 18 delegated members of centers afferent to Peritoneal Surface Malignancies Oncoteam of the Italian Society of Surgical Oncology was established. A list of statements regarding the DTA of patients with CRCPM was prepared according to different activities and decision-making nodes with a defined entry and exit point. Consensus was obtained through RAND UCLA methodology. Results: two different DTA were defined and approved according to the modality of presentation of CRCPM (synchronous and metachronous). A consensus was also obtained on 17 of the 19 statements related to DTA. Conclusion: a shared model of DTA is now available for healthcare providers to monitor appropriateness in diagnosis and treatment of patients with isolated peritoneal metastases from CRC.

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“…Surgical excision is the treatment of choice of MCPM, either by laparoscopy or by laparotomy 40,41 . However, laparoscopy may underestimate the extent of peritoneal carcinosis 42 . MCPM is considered as a borderline tumor with a risk of neoplasic transformation 43,44 .…”

Section: Discussionmentioning

confidence: 99%

Multicystic and diffuse malignant peritoneal mesothelioma in children

Vermersch

Arnaud

Orbach

et al. 2020

Pediatric Blood & Cancer

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Background: Malignant and multicystic peritoneal mesotheliomas are extremely rare tumors in children, developing from mesothelial cells. No specific guidelines are available at this age. Methods: We performed a retrospective analysis of all identified children (< 18-year-old) treated in France from 1987 to 2017 for a diffuse malignant peritoneal mesothelioma (DMPM) or a multicystic peritoneal mesothelioma (MCPM). Results: Fourteen patients (5 males and nine females), aged 2.2 to 17.5 years, were included. The most frequent presenting symptoms were abdominal pain, ascitis, and alteration in the general condition. Eight patients had epithelioid mesothelioma, three had biphasic mesothelioma, and three had MCPM. Eight patients with DMPM diagnosis received cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC). Among them, six patients had neoadjuvant systemic chemotherapy, one patient, post-operative chemotherapy, and one patient CRS and HIPEC only. Three patients received only systemic chemotherapy. All patients with MCPM had only surgery. After a median follow-up of seven years (2-15), six patients (6/11; one death) with DMPM and two patients (two/three) with MCPM had a local and distant recurrences. Conclusion: Peritoneal mesothelioma in children is a rare condition with difficult diagnosis and high risk of recurrence. Worldwide interdisciplinary collaboration and networking are mandatory to help diagnosis and provide harmonious treatment guidelines.

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Multicentre study of laparoscopic or open assessment of the peritoneal cancer index (BIG-RENAPE)

Abstract: Laparoscopy may underestimate the extent of CRPM.

Cited by 70 publications

References 14 publications

Diffusion-weighted MRI assessment of the peritoneal cancer index before cytoreductive surgery

Diffusion-weighted MRI assessment of the peritoneal cancer index before cytoreductive surgery

Diagnostic and therapeutic algorithm for colorectal peritoneal metastases. A consensus of the peritoneal surface malignancies onco-team of the Italian society of surgical oncology

Multicystic and diffuse malignant peritoneal mesothelioma in children

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