Omental metastases in patients with pseudomyxoma peritonei or colorectal peritoneal metastases - is routine omentectomy justified?

IF 3 3区 医学 Q2 ONCOLOGY International Journal of Hyperthermia Pub Date : 2024-01-01 Epub Date: 2024-06-27 DOI:10.1080/02656736.2024.2372356
Malin Enblad, Helgi Birgisson, Lana Ghanipour, Peter Cashin, Wilhelm Graf
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Abstract

Background: The greater omentum is routinely resected during cytoreductive surgery (CRS), but few studies have analyzed the rationale behind this. This study aimed to assess the prevalence of omental metastases (OM) and the correlation between macroscopically suspected and microscopically confirmed OM, in patients with pseudomyxoma peritonei (PMP) or colorectal peritoneal metastases (PM).

Method: All patients without previous omentectomy, treated with initial CRS and hyperthermic intraperitoneal chemotherapy for PMP or colorectal PM, at Uppsala University Hospital in 2013-2021, were included. Macroscopic OM in surgical reports was compared with histopathological analyses.

Results: In all, 276 patients were included. In those with PMP, 112 (98%) underwent omentectomy and 67 (59%) had macroscopic suspicion of OM. In 5 (4%) patients, the surgeon was uncertain. Histopathology confirmed OM in 81 (72%). In patients with macroscopic suspicion, 96% had confirmed OM (positive predictive value, PPV). In patients with no suspicion, 24% had occult OM (negative predictive value, NPV = 76%). In patients with colorectal PM, 156 (96%) underwent omentectomy and 97 (60%) had macroscopic suspicion. For 5 (3%) patients, the surgeon was uncertain. OM was microscopically confirmed in 90 (58%). PPV was 85% and NPV was 89%. The presence of OM was a univariate risk factor for death in PMP (HR 3.62, 95%CI 1.08-12.1) and colorectal PM (HR 1.67, 95%CI 1.07-2.60), but not in multivariate analyses.

Conclusion: OM was common and there was a high risk of missing occult OM in both PMP and colorectal PM. These results support the practice of routine omentectomy during CRS.

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腹膜假性肌瘤或结直肠腹膜转移患者的网膜转移--常规网膜切除术是否合理?
背景:囊肿切除手术(CRS)通常会切除大网膜,但很少有研究分析其背后的原因。本研究旨在评估腹膜假性肌瘤(PMP)或结直肠腹膜转移瘤(PM)患者中网膜转移瘤(OM)的发生率以及宏观疑似OM与微观确诊OM之间的相关性:方法:纳入2013-2021年乌普萨拉大学医院所有既往未接受过卵巢切除术、因假性腹膜肌瘤或结直肠腹膜转移瘤接受过初始CRS和腹腔内热化疗的患者。将手术报告中的宏观OM与组织病理学分析进行比较:结果:共纳入 276 例患者。在PMP患者中,112人(98%)接受了网膜切除术,67人(59%)在宏观镜下怀疑有OM。5名(4%)患者的外科医生无法确定。81例(72%)患者的组织病理学证实为OM。在有宏观怀疑的患者中,96%确诊为 OM(阳性预测值,PPV)。在没有怀疑的患者中,24% 患有隐性 OM(阴性预测值,NPV = 76%)。在结直肠 PM 患者中,156 人(96%)接受了网膜切除术,97 人(60%)有宏观怀疑。5名(3%)患者的外科医生不确定。90例(58%)经显微镜确诊为OM。PPV为85%,NPV为89%。OM的存在是PMP(HR 3.62,95%CI 1.08-12.1)和结直肠PM(HR 1.67,95%CI 1.07-2.60)死亡的单变量风险因素,但在多变量分析中并非如此:结论:OM很常见,而且在PMP和结肠直肠癌PM中漏诊隐匿性OM的风险很高。这些结果支持在 CRS 期间进行常规卵巢切除术的做法。
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来源期刊
CiteScore
5.90
自引率
12.90%
发文量
153
审稿时长
6-12 weeks
期刊介绍: The International Journal of Hyperthermia
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