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

Thejus T Jayakrishnan, Anthony J Zacharias, Avishkar Sharma, Sam G Pappas, T Clark Gamblin, Kiran K Turaga, Thejus T Jayakrishnan, Anthony J Zacharias, Avishkar Sharma, Sam G Pappas, T Clark Gamblin, Kiran K Turaga

Abstract

Background: We 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).

Methods: A 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.

Results: Of 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.

Conclusions: Laparoscopy 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.

Figures

Figure 1
Figure 1
Flowchart depicting the outcomes of diagnostic laparoscopy (DL). CRS, cytoreductive surgery; HIPEC, hyperthermic intraperitoneal chemotherapy.
Figure 2
Figure 2
Flowchart depicting the outcomes of patients who did not undergo diagnostic laparoscopy. CRS, cytoreductive surgery; HIPEC, hyperthermic intraperitoneal chemotherapy; DPAM, disseminated peritoneal adenomucinosis.

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Source: PubMed

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