ABDOMINAL COMPUTED TOMOGRAPHIC SCAN IN THE SELECTION OF PATIENTS WITHMUCINOUS PERITONEAL CARCINOMATOSIS FOR CYTOREDUCTIVE SURGERY

BACKGROUND: Cytoreductive surgery and intraperitoneal chemotherapy hav e been used to treat peritoneal carcinomatosis, A complete surgical re section is required for optimal results to be achieved, This study eva luated the preoperative computed tomographic (CT) findings in patients with mucinous peritoneal carcinomatosis in order to predict the proba bility of a complete resection, STUDY DESIGN: Computed tomographic sca ns of the abdomen and pelvis were reviewed retrospectively in 45 patie nts with a diagnosis of mucinous peritoneal carcinomatosis who were tr eated with surgery and intraperitoneal chemotherapy, According to the completeness of cytoreduction, patients were divided into two groups, Patients in the first group (n=25) had complete cytoreduction (CR) wit h no tumor deposits 2.5 mm in diameter or larger left behind. The surg ical resection of tumor was incomplete in the second group of patients (n=20), Sixteen CT parameters were initially examined in each group o f patients and statistically evaluated according to the completeness o f the cytoreductive surgical procedure, RESULTS: The incidences of six CT findings were significantly different in the two groups of patient s. These findings were: tumor volume in small bowel mesentery (p<0.001 ), tumor volume in proximal jejunum (p=0.003), tumor volume in distal jejunum (p=0.002), tumor volume in proximal ileum (p=0.003), mesentery configuration (p<0.001), and obstruction of bowel segments by tumor ( p<0.001), A statistical approach using a tree-structured diagram showe d that patients with both obstruction of bowel segments by tumor and t umor diameter greater than 0.5 cm on small bowel surfaces exclusive of distal ileum on preoperative CT scan, had an 88 percent probability o f incomplete resection, Patients without these two CT findings had a 9 2 percent probability of complete resection, CONCLUSIONS: This study s how that selection criteria for patients with mucinous peritoneal carc inomatosis are available on a preoperative CT scan of the abdomen and pelvis, Patients whose scans show obstruction of bowel segments by tum or and tumor diameter greater than 0.5 cm on small bowel surfaces excl usive of distal ileum are unlikely to be candidates for cytoreductive surgery for the treatment of peritoneal carcinomatosis.