Pathological assessment of cytoreductive surgery specimens and its unexplored prognostic potential-a prospective multi-centric study

Aditi Bhatt; Yutaka Yonemura; Nazim Benzerdjeb; Sanket Mehta; Suniti Mishra; Loma Parikh; Praveen Kammar; Mita Y Shah; Aruna Prabhu; Sakina Shaikh; Mahesh D Patel; Sylvie Isaac; Olivier Glehen

doi:10.1016/j.ejso.2019.07.019

Pathological assessment of cytoreductive surgery specimens and its unexplored prognostic potential-a prospective multi-centric study

Eur J Surg Oncol. 2019 Dec;45(12):2398-2404. doi: 10.1016/j.ejso.2019.07.019. Epub 2019 Jul 16.

Authors

Aditi Bhatt¹, Yutaka Yonemura², Nazim Benzerdjeb³, Sanket Mehta⁴, Suniti Mishra⁵, Loma Parikh⁶, Praveen Kammar⁴, Mita Y Shah⁷, Aruna Prabhu⁸, Sakina Shaikh⁹, Mahesh D Patel⁹, Sylvie Isaac³, Olivier Glehen¹⁰

Affiliations

¹ Dept. of Surgical Oncology, Zydus Hospital, Ahmedabad, India. Electronic address: aditimodi31@gmail.com.
² Peritoneal Metastases Center, Kishiwada Tokushukai Hospital, Osaka, Japan.
³ Dept. of Pathology, Centre Hospitalier Lyon-sud, Lyon, France.
⁴ Dept. of Surgical Oncology, Saifee Hospital, Mumbai, India.
⁵ Dept. of Pathology, Fortis Hospital, Bangalore, India.
⁶ Dept. of Pathology, Zydus Hospital, Ahmedabad, India.
⁷ Dept. of Pathology, Saifee Hospital, Mumbai, India.
⁸ Dept of Surgical Oncology, Thangam Cancer Centre, Nammakkal, India.
⁹ Dept. of Surgical Oncology, Zydus Hospital, Ahmedabad, India.
¹⁰ Dept. of Surgical Oncology, Centre Hospitalier Lyon-sud, Lyon, France.

PMID: 31337527
DOI: 10.1016/j.ejso.2019.07.019

Abstract

Background and aim: The grade/histological subtype is one of the most important prognostic markers in patients undergoing cytoreductive surgery (CRS). Our aim was to study other potential prognostic information that can be derived from the pathological evaluation of CRS specimens and provide a broad outline for evaluation of these.

Methods: This prospective study (July to December 2018) included all patients undergoing cytoreductive surgery (CRS). A protocol for pathological evaluation was laid down which was based on existing practices at the participating centers and included evaluation of the pathological PCI, regional node involvement, response to chemotherapy, morphology of peritoneal metastases (PM) and distribution in the peritoneal cavity.

Results: In 191 patients undergoing CRS at 4 centers, the pathological and surgical PCI differed in over 75%. Nodes in relation to peritoneal disease were positive in 13.6%. Disease in normal peritoneum adjacent to tumor nodules was seen in >50% patients with ovarian cancer and mucinous apppendiceal tumors. 23.8% of evaluated colorectal PM patients had a complete response and 25.0% ovarian cancer patients had a near complete pathological response to chemotherapy.

Conclusions: Pathological evaluation of extent and distribution of peritoneal disease differs from the surgical evaluation in majority of the patients. Lymph node involvement in relation of peritoneal disease is common. The morphological presentation of PM in ovarian cancer and mucinous appendiceal tumors merits evaluation of more extensive resections in these patients. Standardized methods of synoptic reporting of CRS specimens could help capture vital prognostic information that may in future influence how these patients are treated.

Keywords: Cytoreductive surgery; Lymph node metastases; Pathological PCI; Pathological evaluation; Peritoneal metastases; Synoptic reporting.

Publication types

Multicenter Study

MeSH terms

Aged
Chemotherapy, Adjuvant
Cytoreduction Surgical Procedures*
Female
Humans
Lymphatic Metastasis
Male
Middle Aged
Neoadjuvant Therapy
Peritoneal Neoplasms / drug therapy
Peritoneal Neoplasms / secondary*
Peritoneal Neoplasms / surgery*
Prognosis
Prospective Studies