CT in the selection of patients with abdominal or pelvic sarcoma for reoperative surgery

Background: Retroperitoneal or visceral sarcoma may recur with disease limi ted to the abdomen and pelvis. In this clinical situation, further surgical treatments in an attempt to control the disease may be appropriate. CT is used to help select patients for additional surgical interventions. Study Design: Preoperative abdominal and pelvic CT scans of 33 patients wit h recurrent sarcoma were reviewed retrospectively. All patients underwent r eoperative surgery and, when appropriate, perioperative intraperitoneal che motherapy. Patients were divided into two groups according to survival and disease status: alive with no evidence of disease (n = 7) and alive with di sease or dead of disease (n = 26). Twenty-two CT indices were studied retro spectively for each patient and evaluated statistically. Results: The presence of large (greater than 5 cm) tumor volume in 3 of the 13 abdominopelvic regions resulted in a significant difference in the prog nosis between the groups of patients. These findings included tumor,in the left lower quadrant (p = 0.032), tumor in the pelvis (p = 0.008), and tumor in the distal jejunum (p = 0.032). Two other CT indices that showed a sign ificant difference in survival between the groups were involvement of five abdominopelvic regions or fewer (p = 0.008) and a peritoneal cancer index o f 15 or less (p = 0.03). A statistical approach using a tree-structured dia gram showed that patients with tumor diameter greater than 5 cm in the pelv is accompanied by tumor involvement of more than one segment of small bowel had a 0% probability of postoperative disease-free survival. In contrast, patients with tumor diameter less than 5 cm in the pelvis on CT had an 86% probability of disease-free survival. Conclusions: For patients with recurrent sarcoma, selection criteria were g enerated by a preoperative CT of the abdomen and pelvis. In this disease, C T was a reliable diagnostic test for predicting benefit from further surgic al interventions and should be used in the future to help select patients f or an aggressive versus a palliative approach. (J Am Coll Surg 2000;190:700 -710. (C) 2000 by the American College of Surgeons).