In Reply We thank Bhatt and colleagues for their interesting comments on our article.1 First, they consider the median baseline peritoneal cancer index (PCI) of 5 to be low. Importantly, the surgical baseline PCI was determined by laparoscopy in 74% of patients. Compared with laparotomy, laparoscopy may underestimate the PCI.2 This potential underestimation is reflected by the higher median PCI of 9 during cytoreductive surgery (CRS), which is similar to the PCI during CRS in recent Dutch multicenter cohort studies3 and other randomized clinical trials (eg, PRODIGE74) studying colorectal peritoneal metastases (CPM). Although this comparison suggests representative disease extent of our trial population, we agree that it could be valuable to compare the PCI between enrolled patients and patients not approached for trial participation. Because we did not analyze these data during phase 2, we aim to collect these during phase 3 to increase insight in the trial’s external validity.
Rovers KP, Bakkers C, de Hingh IHJT. New Insights on the Treatment of Colorectal Peritoneal Metastases From the CAIRO6 Trial—Reply. JAMA Surg. 2022;157(2):171–172. doi:10.1001/jamasurg.2021.5025
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