A novel safe approach to laparoscopic colorectal cancer resection in patients with ventriculoperitoneal shunt: report of two cases and literature review

Abstract

There is ongoing challenges regarding the safety of performing laparoscopic surgery with the presence of ventriculoperitoneal (VP) shunts, especially in patients treated for cancer disease. To date, only one case has been reported in the English literature. Herein, we report an additional two cases of patients with previous insertion of a VP shunt, diagnosed with colon cancer. Both our patients underwent successful laparoscopic colectomies, without clamping or removal of the VP shunt, with no reported perioperative complications or postoperative neurological deficits. Laparoscopic bowel resection for cancer, in patients with a pre-existing VP shunt, could be considered a potentially safe and feasible procedure. Furthermore, due to the increasing number of patients with VP shunts, additional case reports and investigations are warranted to further confirm safety of this procedure.

Resection of solitary abdominal wall metastasis of ascending colon cancer along the ventriculoperitoneal shunt: A case report

“…Neale et al reported that if the pneumoperitoneum pressure did not exceed 80 mmHg, no cerebrospinal fluid reflux occurs in the VP shunt [ 9 ]. Therefore, laparoscopic surgery with pneumoperitoneum pressure of 8–10 mmHg generally does not cause reflux in the VP shunt, and there have been many reports of laparoscopic procedures performed with the VP shunt that ended without trouble [ 10 , 11 ].…”

Laparoscopic Resection of Advanced Colorectal Cancer in a Patient with Lumboperitoneal Shunt

“…However, it is a topic of concern that due to CO 2 insufflation, the pneumoperitoneum may induce CSF shunt-related spread of cancer cells such as subcutaneous seeding or retrograde metastasis [ 3 , 4 ]. Recently, long-term outcomes of large, randomized trials comparing open and laparoscopic surgeries for colorectal cancer demonstrated the noninferiority of laparoscopic surgery for treating T4 tumors and an actual incidence of port-site metastasis of approximately 1%, which is not significantly different from wound recurrence rate after open colorectal surgery [ 17 ].…”

“…As the demand for minimally invasive surgeries increases, most abdominal surgeries are now being performed laparoscopically. Although there are several reports on laparoscopic surgery for patients with CSF shunt, laparoscopic colectomy for patients with CSF shunt has been rarely reported [ 2 – 4 ].…”