A 62-year-old patient with linitis plastica on CT (diffuse gastric wall thickening, absence of peristalsis) and signet-ring cell adenocarcinoma on biopsy undergoes laparoscopic staging. Diagnostic laparoscopy reveals peritoneal nodules. Which scoring system uses peritoneal cancer index (PCI) and has been used to select patients for cytoreductive surgery + HIPEC in gastric cancer with peritoneal metastasis?
- A Gilly staging system for peritoneal seeding
- B AJCC pM1 staging — all peritoneal disease is uniformly unresectable
- C Jacquet-Sugarbaker PCI (0–39) combined with complete cytoreduction (CC-0/CC-1) ✓
- D Yonsei score for gastric peritoneal metastasis
Explanation
The Peritoneal Cancer Index (Jacquet-Sugarbaker PCI, range 0–39) quantifies peritoneal spread by assessing 13 abdominal regions for lesion size. Combined with complete cytoreduction (CC-0: no visible disease; CC-1: nodules < 2.5 mm), it is used to select patients for cytoreductive surgery (CRS) + hyperthermic intraperitoneal chemotherapy (HIPEC) in gastric cancer peritoneal metastasis. PCI ≤ 6–10 with CC-0/CC-1 resection is associated with better outcomes. While this approach remains investigational for gastric cancer, JCOG trials and PROPHET trial data are informing current guidelines. Linitis plastica itself is a contraindication due to extensive submucosal spread.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.