Concordance Among Radiological, Laparoscopic and Laparotomic Peritoneal Cancer Index Assessments in Patients Undergoing Cytoreductive Surgery for Peritoneal Metastases.
Silvia Guerrero-Macías, Vaneza Ávila-Rodríguez, Jorge Andrés Urrutia-Gómez, Daniel Upegui, Carlos Bonilla, Álvaro Arjona-Sánchez
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Abstract
Background: Accurate estimation of the Peritoneal Cancer Index (PCI) is essential for selecting patients with peritoneal metastases who may benefit from cytoreductive surgery (CRS). Although cross-sectional imaging is routinely used for preoperative staging, its ability to reflect intraoperative tumor burden remains imperfect. Diagnostic laparoscopy may provide additional information in selected cases.
Methods: We conducted a retrospective cohort study of patients who underwent CRS for peritoneal metastases at a tertiary cancer center between August 2023 and February 2025. Radiologic PCI (rPCI) was compared with intraoperative PCI assessed during open surgery (crsPCI). In patients who underwent diagnostic laparoscopy, laparoscopic PCI (lapPCI) was also compared with crsPCI. Agreement between methods was evaluated using correlation and concordance analyses.
Results: Fifty-six patients were included in the radiologic analysis, and 16 underwent diagnostic laparoscopy before CRS. Radiologic PCI demonstrated good agreement with intraoperative PCI but tended to underestimate the extent of peritoneal disease. Laparoscopic PCI showed closer agreement with surgical PCI than radiologic assessment. However, the laparoscopic subgroup was small and predominantly composed of patients with gastric cancer, limiting the generalizability of these findings.
Conclusions: In this selected surgical cohort, radiologic PCI provided a reasonable estimate of intraoperative tumor burden but consistently underestimated disease extent. Diagnostic laparoscopy appeared to improve concordance with surgical PCI and may offer complementary staging information in selected high-risk or borderline cases, particularly when imaging findings are equivocal. Given the limited size and selected nature of the laparoscopic subgroup, these results should be interpreted cautiously and viewed as supportive rather than definitive evidence for the routine use of laparoscopy across all tumor types.
期刊介绍：
The Journal of Gastrointestinal Cancer is a multidisciplinary medium for the publication of novel research pertaining to cancers arising from the gastrointestinal tract.The journal is dedicated to the most rapid publication possible.The journal publishes papers in all relevant fields, emphasizing those studies that are helpful in understanding and treating cancers affecting the esophagus, stomach, liver, gallbladder and biliary tree, pancreas, small bowel, large bowel, rectum, and anus. In addition, the Journal of Gastrointestinal Cancer publishes basic and translational scientific information from studies providing insight into the etiology and progression of cancers affecting these organs. New insights are provided from diverse areas of research such as studies exploring pre-neoplastic states, risk factors, epidemiology, genetics, preclinical therapeutics, surgery, radiation therapy, novel medical therapeutics, clinical trials, and outcome studies.In addition to reports of original clinical and experimental studies, the journal also publishes: case reports, state-of-the-art reviews on topics of immediate interest or importance; invited articles analyzing particular areas of pancreatic research and knowledge; perspectives in which critical evaluation and conflicting opinions about current topics may be expressed; meeting highlights that summarize important points presented at recent meetings; abstracts of symposia and conferences; book reviews; hypotheses; Letters to the Editors; and other items of special interest, including:Complex Cases in GI Oncology: This is a new initiative to provide a forum to review and discuss the history and management of complex and involved gastrointestinal oncology cases. The format will be similar to a teaching case conference where a case vignette is presented and is followed by a series of questions and discussion points. A brief reference list supporting the points made in discussion would be expected.
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