The role of single-incision laparoscopic peritoneal exploration in the management of patients with peritoneal metastases

Najah, H.; Malgras, Brice; Dohan, Anthony; Gronnier, Caroline; Eveno, Clarisse; Pocard, Marc

doi:10.1007/s00464-019-06984-8

Cited by 5 publications

(9 citation statements)

References 37 publications

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“…In consideration of the high peri-operative mortality and morbidity of pancreatic surgery, non-curative exploratory laparotomy of pancreas should be avoided. Najah et al indicated that single-incision laparoscopic peritoneal exploration could be safely applied in the management of patients with peritoneal metastases (17). Several studies have concluded that compared to laparotomy, diagnostic laparoscopy routinely used not only saves patients an incision, but also shortens the intervals between operation and adjuvant therapy (18)(19)(20).…”

Section: Discussionmentioning

confidence: 99%

A nomogram of preoperative predictors for occult metastasis in patients with PDAC during laparoscopic exploration

Ge¹,

Li²,

Ma³

et al. 2021

Gland Surg

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Background: Surgical resection is the only potentially curative treatment for pancreatic ductal adenocarcinoma (PDAC). However, most of patients lose the chance of surgery due to the unresectable disease at the time of diagnosis. Despite the improvement of radiological imaging, a portion of patients intended for radical resection were proven to be unresectable at surgical exploration due to occult metastasis.Methods: Patients who were aimed to undergo radical pancreatectomy for PDAC from 2010 to 2019 were reviewed retrospectively. All patients included underwent diagnostic laparoscopic exploration. Patients were divided into two groups depending on whether distant metastasis were encountered during exploration.Univariate and multivariate logistic regression analyses were used to identify risk factors for occult metastasis.A nomogram to predict occult metastasis of PDAC on exploration was developed and evaluated.Results: A total of 273 patients who underwent diagnostic laparoscopic exploration were included in this study. Nineteen (7.0%) patients were found with distant metastasis during exploration. Multivariate logistic regression analysis showed that ALT>40U/L, CA19-9, CA125 and regional nodes enlargement were independent predictors for occult metastasis. Incorporating these four factors, the nomogram achieved concordance index of 0.799, with a well-fitted calibration curve.Conclusions: Occult metastasis is not unusual during surgical exploration in patients with resectable or borderline resectable PDAC. The nomogram could achieve a personal prediction of unexpected distant metastasis on exploration. It may help to sift through patients with PDAC who would benefit from laparoscopic exploration.

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Section: Discussionmentioning

confidence: 99%

A nomogram of preoperative predictors for occult metastasis in patients with PDAC during laparoscopic exploration

Ge¹,

Li²,

Ma³

et al. 2021

Gland Surg

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“…Therefore, on the one hand, occult PM status could be identified based on our easy-to-use and individualized model, and optimal candidates for exploratory laparoscopy could be determined. On the other hand, via exploratory laparoscopy, physicians could evaluate the feasibility of CRS depending on the PCI and CCR ( 13 , 22 ).…”

Section: Discussionmentioning

confidence: 99%

“…Second, although sequencing technology has become less expensive and tumor genotyping has become standard practice for pmCRC, the sample size of genes was relatively small, especially for mutation status, which may have limited its statistical power. Third, some studies found that the PCI score were underestimated for laparoscopy compared to laparotomy ( 13 , 47 ). Even though it may underestimate PCI, exploratory laparoscopy accurately predicts the possibility of CCR.…”

Section: Discussionmentioning

confidence: 99%

“…A standardized exploration of the peritoneal cavity was conducted quadrant by quadrant using the endoscope, exploring the 13 regions of PCI as described by Sugarbaker ( 22 ). The procedures were only exploratory, and no extensive dissection was made ( 13 , 23 ).…”

Section: Methodsmentioning

confidence: 99%

“…At present, diagnostic laparoscopy has been regarded as the most reliable tool to detect occult PM because it could provide direct visualization as well as histological confirmation, and could evaluate the extent of the disease, measured in terms of PCI (12)(13)(14). Meanwhile, some recent studies support the laparoscopy's safety and efficacy either in the excision of lesions or in the selection of potential PM candidates for CRS/ HIPEC (15)(16)(17)(18)(19).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

A Prediction Model Intended for Exploratory Laparoscopy Risk Stratification in Colorectal Cancer Patients With Potential Occult Peritoneal Metastasis

Zhang

Qin

et al. 2022

Front. Oncol.

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BackgroundThe early diagnosis of occult peritoneal metastasis (PM) remains a challenge due to the low sensitivity on computed tomography (CT) images. Exploratory laparoscopy is the gold standard to confirm PM but should only be proposed in selected patients due to its invasiveness, high cost, and port-site metastasis risk. In this study, we aimed to develop an individualized prediction model to identify occult PM status and determine optimal candidates for exploratory laparoscopy.MethodA total of 622 colorectal cancer (CRC) patients from 2 centers were divided into training and external validation cohorts. All patients’ PM status was first detected as negative on CT imaging but later confirmed by exploratory laparoscopy. Multivariate analysis was used to identify independent predictors, which were used to build a prediction model for identifying occult PM in CRC. The concordance index (C-index), calibration plot and decision curve analysis were used to evaluate its predictive accuracy and clinical utility.ResultsThe C-indices of the model in the development and validation groups were 0.850 (95% CI 0.815-0.885) and 0.794 (95% CI, 0.690-0.899), respectively. The calibration curve showed consistency between the observed and predicted probabilities. The decision curve analysis indicated that the prediction model has a great clinical value between thresholds of 0.10 and 0.72. At a risk threshold of 30%, a total of 40% of exploratory laparoscopies could have been prevented, while still identifying 76.7% of clinically occult PM cases. A dynamic online platform was also developed to facilitate the usage of the proposed model.ConclusionsOur individualized risk model could reduce the number of unnecessary exploratory laparoscopies while maintaining a high rate of diagnosis of clinically occult PM. These results warrant further validation in prospective studies.Clinical Trial Registrationhttps://www.isrctn.com, identifier ISRCTN76852032

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The Diagnostic Role of Laparoscopy in Patients with Peritoneal Malignancy

Brandl

Rau

2021

Peritoneal Tumors and Metastases

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The role of single-incision laparoscopic peritoneal exploration in the management of patients with peritoneal metastases

Cited by 5 publications

References 37 publications

A nomogram of preoperative predictors for occult metastasis in patients with PDAC during laparoscopic exploration

A nomogram of preoperative predictors for occult metastasis in patients with PDAC during laparoscopic exploration

A Prediction Model Intended for Exploratory Laparoscopy Risk Stratification in Colorectal Cancer Patients With Potential Occult Peritoneal Metastasis

The Diagnostic Role of Laparoscopy in Patients with Peritoneal Malignancy

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