Preoperative criteria of incomplete resectability of peritoneal carcinomatosis from non-appendiceal colorectal carcinoma

Objective - To analyse the causes of non resectability of peritoneal carcinomatosis (PC) of non-appendiceal colorectal carcinomas, discovered only at the time of the laparotomy. Summary background data - The combination of a maximal cytoreductive surgery (resecting tumor deposits > 1 mm in diameter) with intraperitoneal chemohyperthermia results in cure a significant number of patients. Complete resection of the PC is the determining factor of this time-consuming and resource-consuming therapy. Unfortunately, it has not been possible, so far, to safely predict complete resectability before carrying out the laparotomy. Methods - All patients with colorectal PC who had undergone a laparotomy in order to receive this new treatment, but who finally presented a non completely resectable PC were included in our study. Their preoperative parameters were retrospectively studied and compared to matched number of patients who had successfully undergone this treatment. Results - 29 patients had incomplete resection PC at laparotomy. They were compared with 29 matched patients who underwent a complete resection of the PC. The factors predicting non resectability were, in decreasing order of frequency: presence or persistence of an ascitis just before the laparotomy (P = 0.0008), progression of the PC while on neo-adjuvant chemotherapy (P = 0.01), abnormal CT-imaging (P = 0.03), and sub-occlusive syndrome (P = 0.05). These parameters were partially inter-related. Conclusion - The persistence of ascitis and any progression of the disease while on chemotherapy are important predictive factors of incomplete resectability of non-appendiceal colorectal PC.