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5.1. Which one is the current best method to assess the residual disease after cytoreductive surgery in patients affected by peritoneal surface malignancies? (just one alternative allowed)
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AJCC R classification ([30]) with Dutch modification (R0 and R1: no macroscopic; R2a <2.5mm and R2b>2.5mm); ([31],[32])
First round: 9,68 % - Second round: 6,25 % |
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AJCC R classification (1) with French modification (R0 and R1: no macroscopic; R2 macroscopic disease);([33])
First round: 12,90 % - Second round: 0 % |
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AJCC R classification (1) with American modification (R0: no gross disease with negative microscopic margins; R1: no gross disease with positive microscopic margins; R2a: <5mm, R2b: tumors of 6 to 20 mm and R2c: tumours of >20 mm);([34])
First round: 3,23 % - Second round: 0 % |
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Completeness of cytoreduction score.([35])
First round: 74,19 % - Second round: 93,75 % |
5.2. What should be the ideal method to assess residual disease size after cytoreductive surgery? (just one alternative allowed)
|
The experienced surgeon´s naked-eye estimation;
First round: 38,71 % - Second round: 65,63 % |
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Direct measurement by a sterile rule or calliper;
First round: 25,81 % - Second round: 18,75 % |
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The average of the naked-eye estimation of all members of the operating team.
First round: 35,48 % - Second round: 15,63 % |
5.3. Consider the case of a young patient affected by pseudomyxoma peritonei undergoing cytoreductive surgery. Initial PCI is 35, operating time including HIPEC is 11 hours, and there are no apparent visible disease nodules at the end of a very laborious cytoreductive procedure. What is your completeness of cytoreduction scoring?
(just one alternative allowed)
|
CC-0;
First round: 70,97 % - Second round: 75,00 % |
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CC-1;
First round: 25,81 % - Second round: 25,00 % |
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other.
First round: 3,23 % - Second round: 0 % |
5.4. Consider the same case. What is your R scoring?
(just one alternative allowed)
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R0;
First round: 48,39 % - Second round: 25,00 % |
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R1;
First round: 48,39 % - Second round: 75,00 % |
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other.
First round: 3,23 % - Second round: 0 % |
5.5. Would you favour a further specification in the definition of a CC-0 or R0 cytoreduction? (just one alternative allowed)
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yes;
First round: 58,06 % - Second round: 75,00 % |
|
no.
First round: 41,94 % - Second round: 25,00 % |
5.6. Would you favour a redefinition of the completeness of cytoreduction according to the disease process?
(just one alternative allowed)
|
yes;
First round: 54,84 % - Second round: 78,13 % |
|
no.
First round: 45,16 % - Second round: 21,88 % |
5.7. Would you favour a redefinition of the completeness of cytoreduction according to the type of intraperitoneal cytotoxic agent(s) employed? (just one alternative allowed)
|
yes;
First round: 29,03 % - Second round: 21,88 % |
|
no.
First round: 70,97 % - Second round: 78,13 % |
| [30] American Joint Committee on Cancer: “ Manual for Staging on Cancer, “ 4th ed. Philadelfphia: Lippincott, 1992. |
| [31] Verwaal VJ, van Ruth S, Witkamp A, Boot H, van Slooten G, Zoetmulder FA. Long-term survival of peritoneal carcinomatosis of colorectal origin. Ann Surg Oncol. 2005 Jan;12(1):65-71. Epub 2004 Dec 27. |
| [32] de Bree E, Koops W, Kroger R, van Ruth S, Verwaal VJ, Zoetmulder FA. Preoperative computed tomography and selection of patients with colorectal peritoneal carcinomatosis for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Eur J Surg Oncol. 2006 Feb;32(1):65-71. Epub 2005 Nov 14. |
| [33] O Glehen, F Mithieux and D Osinsky et al. Surgery combined with peritonectomy procedures and intraperitoneal chemohyperthermia in abdominal cancers with peritoneal carcinomatosis: a phase II study, J Clin Oncol 21 (2003), pp. 799–806. |
| [34] Stewart JH 4th, Shen P, Levine EA. Intraperitoneal hyperthermic chemotherapy for peritoneal surface malignancy: current status and future directions. Ann Surg Oncol. 2005 Oct;12(10):765-77. Epub 2005 Aug 18. Review. |
| [35] Jacquet P, Sugarbaker PH. Clinical research methodologies in diagnosis and staging of patients with peritoneal carcinomatosis. Cancer Treat Res. 1996;82:359-74. Review. |
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