To What Extent Peritonitis Carcinomatosa Can Foreseeable in Digestive System Tumors?

INTRODUCTION: Peritoneal dissemination may develop in many digestive system and gynecological cancers. Despite advances in imaging technologies, it is difficult to diagnose PC induced by digestive system tumors before surgery.
METHODS: In this study, staging tests used in patients with PC that unidentified preoperatively were reviewed retrospectively. Eighty-two patients were evaluated in between January 2012 and November 2015.
RESULTS: Forty-five (54.8%) patients had been operated with stomach cancer, 24 patients (29.2%) with colorectal, and 13 patients (15.8%), pancreas and biliary tract cancers. Computerized Tomography (CT) was taken to all patients for staging, 26 patients were also evaluated with abdominal ultrasonography (USG) and 4 patients with magnetic resonance imaging (MRI). Positron Emission Tomography (PET-CT) was applied to eight patients. While 40 (48.7%) patients underwent surgical bypass and other palliative procedures, no additional surgical procedures were performed in 42 patients. In our series of patients who all have undergone laparotomy, all patients were evaluated with preoperative CT and suspicious findings identified in 10 patients were interpreted as not being specific to quit laparotomy. The most suspicious findings were reported in PC patients with gastric cancer (8/45). In our study, the PET/CT findings of 4 out of 8 patients evaluated were interpreted as suspicious, but they were not strong enough to exclude PC.
DISCUSSION AND CONCLUSION: It is still difficult to diagnose PC before surgery with conventional radiological imaging techniques. Combined use of different imaging modalities together can increase the success rate. It should be known that the probability of PC is especially high in patients with tumor marker elevation and locally advanced and borderline resectable disease findings. If palliative interventions are not planned in these patients, staging laparoscopy emerges as a suitable alternative.

Sindirim Sistemi Tümörlerinde Peritonitis Karsinomatoza Ne Kadar Öngörülebilir?

GÝRÝÞ ve AMAÇ: Birçok sindirim sistemi ve jinekolojik kansere baðlý olarak peritoneal yayýlým geliþebilir. Görüntüleme yöntemlerindeki geliþmelere raðmen sindirim sistemi kaynaklý tümörlere baðlý geliþen peritonitis karsinomatoza’yý (PC) ameliyat öncesi tanýmak güçtür.
YÖNTEM ve GEREÇLER: Bu çalýþmada ameliyat öncesi tanýmlanamayan PC saptanan hastalarýn evreleme tetkikleri geriye dönük olarak gözden geçirilmiþtir. Ocak 2012- Kasým 2015 tarihleri arasýnda 82 hasta deðerlendirilmiþtir.
BULGULAR: Kýrkbeþ (%54.8) hasta mide, 24 hasta (%29.2) kolorektal, 13 hasta (%15.8) pankreas ve safra yolu kaynaklý tümörler nedeniyle opere edilmiþti. Hastalarýn tümüne evreleme amaçlý Bilgisayarlý Tomografi (BT) çekilmiþ, 26 hastaya ayrýca karýn ultrasonografisi (USG), 4 hastaya Manyetik Rezonans Görüntüleme (MRG) yapýlmýþtýr. Sekiz hastaya ise Pozitron Emisyon Tomografisi (PET-BT) uygulanmýþtýr. Kýrk (%48,7) hastaya cerrahi bypass ve diðer palyatif iþlemler uygulanýrken, 42 hastaya ek cerrahi iþlem uygulanmamýþtýr. Tamamýna laparotomi uygulanmýþ hastalardan oluþan bizim serimizde tüm hastalara preoperatif BT çekilmiþ, on hastada bulgular þüpheli ancak laparotomiden vazgeçirecek kadar spesifik olmadýðý yönünde yorumlanmýþtýr. En fazla þüpheli bulguya mide kaynaklý PC’lý hastalarda rastlanmýþtýr (8/45). Bizim çalýþmamýzda 8 hastaya uygulanan PET/BT’nin 4’ü þüpheli olarak yorumlanmýþ ancak PC varlýðýný dýþlayacak kadar güçlü bulgulara rastlanmamýþtýr.
TARTIÞMA ve SONUÇ: Ameliyat öncesi konvansiyonel radyolojik görüntüleme yöntemleri ile PC’yý saptayabilmek halen güçtür. Farklý görüntüleme yöntemlerinin birlikte kullanýlmasý baþarý oranýný arttýrabilir. Özellikle lokal ileri ve sýnýrda rezektable hastalarda birlikte tümör belirteç yüksekliði de saptanmasý halinde PC ihtimalinin yüksek olduðu bilinmelidir. Bu hastalarda palyatif giriþimler planlanmýyorsa evreleme laparoskopisi uygun bir alternatif olarak karþýmýza çýkmaktadýr.