Journal: Annals of surgical oncology
This prospective single-center study evaluated whether an immediate intraoperative “second look” can improve detection of residual peritoneal metastases in patients with colorectal or ovarian cancer undergoing cytoreductive surgery (CRS) judged as complete (CC0).
– Population & Methods:
- 59 patients with histologically confirmed peritoneal metastases from colorectal (n=35) or ovarian cancer (n=24).
- All underwent CC0 CRS by a senior surgeon.
- Immediately afterward, a second senior surgeon, blinded to the first, performed a systematic re-exploration of the entire peritoneal cavity.
- Any additional suspicious nodules identified on second look were resected and analyzed pathologically.
- Median Peritoneal Cancer Index was 6 (IQR 4–14.5).
– Key Findings:
- The second look led to resection of additional suspicious nodules in 88.1% of patients.
- Pathology confirmed malignancy in these additional nodules in 47.4% of patients.
- The proportion of patients with malignant nodules missed during the initial inspection ranged from 25% to 80% (depending on context not further specified in the abstract).
- Cognitive testing of surgeons before and after CRS showed high levels of attention overall; errors and omissions were rare but consistently present.
– Conclusion:
- Nearly half of patients had residual malignant peritoneal disease despite CRS being initially assessed as complete.
- These results highlight inherent perceptual limits in intraoperative detection and support the role of a structured intraoperative second look to improve thoroughness of cytoreduction in peritoneal metastases from colorectal and ovarian cancer.