Background: Careful macroscopic assessment of surgical scars is needed to avoid routine scar resection during cytoreductive surgery (CRS) for peritoneal metastases (PM). This study aimed to analyze the correlation between macroscopically suspected and microscopically confirmed scar metastases (SMs), and to analyze the prognostic impact of not undergoing routine scar resection. Method: All patients with previous surgery, treated with CRS and hyperthermic intraperitoneal chemotherapy, for colorectal PM or pseudomyxoma peritonei (PMP), at Uppsala University Hospital in 2013–2021, were included. Macroscopic SMs in surgical reports were compared with histopathological analyses. Results: In total, 227 patients were included. Among colorectal PM patients (n = 156), SM was macroscopically suspected in 41 (26%) patients, and 63 (40%) underwent scar resection. SM was confirmed in 19 (30%). Among patients with macroscopic suspicion, 45% had confirmed SM (positive predictive value, PPV). A total of 1 of 23 (4%) patients with no macroscopic suspicion had SM (negative predictive value, NPV = 96%). Among the PMP patients (n = 71), SM was macroscopically suspected in 13 (18%), and 28 (39%) underwent scar resection, of whom 12 (43%) had SM. The PPV was 77%. Occult SM was found in 1 of 14 (NPV = 93%). Not undergoing routine scar resection did not affect recurrence-free survival (RFS,p =0.2) or overall survival (OS,p =0.1) in colorectal PM patients or PMP patients (RFSp =0.7, OSp =0.7). Conclusion: Occult SM is uncommon and scar resection does not affect RFS or OS. Therefore, macroscopically benign-appearing scars can be left without resection, though resection should be performed upon suspicion or uncertainty.
背景：为避免腹膜转移瘤（PM）细胞减灭术（CRS）中常规切除手术瘢痕，需对瘢痕进行细致的肉眼评估。本研究旨在分析肉眼可疑瘢痕转移灶（SM）与病理确诊之间的相关性，并评估未行常规瘢痕切除对预后的影响。方法：纳入2013-2021年间于乌普萨拉大学医院接受CRS联合腹腔热灌注化疗治疗、既往有手术史的结直肠PM或腹膜假黏液瘤（PMP）患者。将手术记录中肉眼可见的SM与组织病理学分析结果进行对比。结果：共纳入227例患者。在结直肠PM患者（n=156）中，41例（26%）存在肉眼可疑SM，63例（40%）接受了瘢痕切除，其中19例（30%）经病理确诊。在肉眼可疑患者中，45%得到病理确认（阳性预测值，PPV）。23例无肉眼可疑表现的患者中仅1例（4%）存在SM（阴性预测值，NPV=96%）。在PMP患者（n=71）中，13例（18%）存在肉眼可疑SM，28例（39%）接受瘢痕切除，其中12例（43%）病理确诊SM，PPV为77%。14例无肉眼可疑表现者中1例发现隐匿性SM（NPV=93%）。未行常规瘢痕切除既不影响结直肠PM患者的无复发生存期（RFS，p=0.2）或总生存期（OS，p=0.1），也不影响PMP患者的RFS（p=0.7）或OS（p=0.7）。结论：隐匿性SM发生率较低，瘢痕切除不影响RFS或OS。因此，肉眼观察良性的瘢痕可不切除，但对可疑或不确定的瘢痕仍应实施切除。
No Indication for Routine Resection of Surgical Scars during Cytoreductive Surgery and HIPEC
肿瘤(癌症)患者之家