Postoperative residual disease evaluation in the locoregional treatment of peritoneal surface malignancy.

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Abstract

Background The maximum size of the residual lesions left behind after cytoreductive surgery for peritoneal surface malignancy has consistently been shown to be the main prognostic factor in this setting. However, a uniform assessment method and categorization for this paramount prognostic indicator is lacking. Methods In order to achieve a consensus among experts, the Delphi methodology was employed. Conflicting points were identified and related multiple choice questions were circulated among a panel of experts on peritoneal surface oncology. Two rounds of web-based voting were carried out. Results The completeness of cytoreduction (CC) Score described by Sugarbaker was considered the current best classification for residual disease size. The experienced surgeon's naked-eye estimation was considered the ideal method to assess residual disease size. There was agreement that the definition of CC-0 or R0 cytoreduction needs further specification. A redefinition of “completeness of cytoreduction” according to disease process was favored by the experts but not favored for the type of intraperitoneal chemotherapy employed. Conclusions Following the experts' consensus, it is recommended that the CC score be used to categorize residual disease after cytoreductive surgery for peritoneal surface malignancy. Pending issues for further consensus development in this area have been identified.