CT-Enteroclysis in the preoperative assessment of the small-bowel involvement in patients with peritoneal carcinomatosis, candidates for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

To assess the performance of CT-Enteroclysis (CTE) in the preoperative evaluation of the small bowel (SB) involvement in patients with peritoneal carcinomatosis (PC), candidates for cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). In this prospective study, 48 consecutive patients (37 women, 11 men, mean age: 57.02 years) with PC of different primaries, eligible for cytoreductive surgery and HIPEC underwent CTE before surgery. Lesions were gathered according to their location (SB wall or mesentery), distribution (jejunum/ileum, proximal/distal) and lesion size (LS, where LS0 is the absence of disease, LS1 < 1 cm, LS < 1-5 cm, and LS3 > 5 cm in maximal diameter). The preoperative CTE classification was correlated with surgical scoring of PC in the SB. CTE was found to have sensitivity 92%, specificity 96%, PPV 97%, NPV 91%, in assessing PC in the SB/mesentery. CTE exhibited "excellent" agreement with surgical classification of disease extent (overall kappa-weighted coefficient of agreement (kappa (w)) was 0.962). Patients (n = 6) found inoperable at surgery manifested extensive plaque-like cover of the SB wall/mesentery on CTE. CTE may be considered a reliable imaging technique for the preoperative evaluation of the extent and distribution of PC in the SB/mesentery in order to assist surgical planning or to prevent unnecessary surgery.