Single-Port Laparoscopic Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy

Abstract

Unusual or unexpected effect of treatment Background: Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy is one of the treatment options in low-grade appendiceal mucinous neoplasm with peritoneal dissemination. The minimal invasive surgery approach was introduced to the field after years of traditional open technique. Multi-port laparoscopic and robotic techniques were reported with good short-term outcomes in very selected patients with low PCI scores. We describe here the first single-port laparoscopic approach of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Case Report: We present a case of low-grade appendiceal mucinous neoplasm with peritoneal dissemination, in which single-port laparoscopic approach of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy was completed through a 5.5-cm incision. A 35-year-old man with no medical illness underwent laparoscopic appendectomy for acute appendicitis 3 months earlier. Postoperative surgical pathology reported a low-grade appendiceal mucinous neoplasm with positive margin. After complete assessment and Tumor Board discussion, the patient was scheduled for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. A single gel port access was inserted through a 5.5-cm peri-umbilical incision. The Peritoneal Cancer Index score was 4, and the decision was made to proceed with partial cecectomy, omentectomy, peritonectomy, and hyperthermic intraperitoneal chemotherapy with the Sugarbaker mitomycin C-based regimen. Postoperative care was carried out following the Enhanced Recovery After Surgery protocol. The patient was discharged on day 3 without any complications. Conclusions: A single-port laparoscopic approach in cytoreductive surgery with hyperthermic intraperitoneal chemotherapy is safe and feasible in very selected patients, and has the advantage of direct visualization and palpation through the incision to determine more accurate Peritoneal Cancer Index assessment in comparison to other MIS approaches. Nevertheless, additional prospective studies are needed.

Is minimal invasive surgical treatment of ovarian cancer plus HIPEC a utopia? A review of the literature

“…The procedure was accompanied with complete cytoreduction in all 11 cases while significantly less blood loss, shorter hospitalization and similar operative times, visceral resections, postoperative morbidities and oncological outcomes after a median follow-up of 11 months were reported. Interestingly, similar encouraging results are presented in a case report by Alshammari et al [2], where for the first time a patient with a low-grade appendiceal mucinous neoplasm successfully underwent CRS including partial cecectomy, omentectomy, peritonectomy and HIPEC via a single port laparoscopic procedure. Single-port approach is in more detail pre-sented in a recent pilot study by Dumont et al [1], where the surgical outcomes of 12 patients with primary peritoneal malignancy treated with this method were presented and operating times as well as the median complication index and the short length of hospital stay confirmed the feasibility of this method to perform CRS and HIPEC, especially in terms of investigation of the small bowel.…”

“…Complete Cytoreductive surgery (CRS) in combination with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in the optimal treatment option in pseudomyxoma peritonei (PMP) and mesothelioma peritonei (MP) patients, providing very satisfying 5-year overall survival rates (80 to 95%) [1]. Furthermore, the same surgical approach can be applied in the treatment of peritoneal dissemination of low-grade appendiceal mucinous neoplasms [2]. In general, CRS plus HIPEC is one of the treatment options for peritoneal spread of advanced stage malignancies originating from the ovaries, the gastrointestinal system and the peritoneal surface, regardless of the origin of peritoneal metastasis (PM), since drug penetration of systemic chemotherapy into PM is known to be low [3].…”