Role of laparoscopy in patients with peritoneal metastases considered for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC)

Abstract

BackgroundWe hypothesized that diagnostic laparoscopy (DL) was feasible for the evaluation of patients with peritoneal carcinomatosis (PC) undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS + HIPEC).MethodsA retrospective review of PC patients treated from January 2010 to April 2013 was conducted. Data on tumor characteristics, treatment details and survival outcomes were extracted and analyzed.ResultsOf the 101 PC patients (mean age 52.9 ± 14.1 years), 73 diagnostic laparoscopies DL (61 concurrent with CRS + HIPEC) were performed in 70 patients whereas 31 patients underwent direct exploratory laparotomy (EL). Complete laparoscopic assessment was possible in 63 cases (86.3%), resulting in 18 exclusions (27.7%) while 10 cases were converted to open due to inadequate laparoscopic visualization. Subsequently, CRS + HIPEC was performed in 85.4% (of 55 selected for HIPEC, DL) versus 74.2% (EL, P value = 0.20). Among those excluded from HIPEC at the initial operation, delayed HIPEC after conversion chemotherapy was achieved in 6 (of 11 with extensive disease, DL). The incidence of grade 3 to 5 complications was 0% DL versus 10% EL (P value = 0.2). There were no port site recurrences at mean follow up of 9.1 ± 8 months.ConclusionsLaparoscopy is a feasible technique for selecting patients with PC for CRS + HIPEC, and can help select patients for conversion chemotherapy in the setting of high peritoneal carcinomatosis index (PCI) score.

1stEvidence-based Italian Consensus Conference on Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Carcinosis from Ovarian Cancer

“…Among these, 499 patients from 8 studies have homogenous clinical characteristics and represent the most homogenous population, on which conclusions can be drawn with a higher level of interest. In this population, the median overall survival is 37.3 months (range 27-78), the median disease-free survival is 14.4 months (range [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30], and the median 5-year overall survival is 40% (range .…”

“…The laparoscopic PI and the laparotomic or laparoscopic PCI have proven to be valid and reproducible instruments for selecting patients with advanced OC (23)(24)(25)(26). (Level II evidence).…”

“…With the mini-invasive approach, it is possible to calculate the PCI as with a laparotomy, to perform the peritoneal washing and potential biopsies to establish the type of the primitive tumor. In addition, it allows for a predictive evaluation of the cytoreduction index and for giving a definite indication on the feasibility and the cost/benefit relationship of the CRS (20)(21)(22)(23)(24)(25)(26). (Level II evidence).…”

Cytoreductive surgery (SRC) for treatment of peritoneal carcinomatosis and hyperthermic ıntraperitoneal chemotherapy (HIPEC): Our initial experience and technical details

“…Laparoscopy is recently being used for CRS and HIPEC for both preoperative evaluation and as a direct surgical technique. It is a valuable technique that can show the presence of peritoneal carcinomatosis or if the disease is inoperable / unresectable before cytoreductive surgery (38). Nevertheless, it should be kept in mind that this method may lead to under/overstaging of the disease (39).…”

Untitled

“…After ruling out significant adhesions at the anterior abdominal wall, systemic visual examination of the abdomen is performed to generate the PCI score. Systemic abdominal examination includes also special attention to per-splenic, peri-hepatic, subdiaphragmatic, pelvic, omental bursa and bowel tumor load [34][35][36].…”