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

World Journal of Surgical Oncology

Kiran K Turaga²  T Clark Gamblin²  Sam G Pappas¹  Avishkar Sharma²  Anthony J Zacharias²  Thejus T Jayakrishnan² 

[1] Division of Surgical Oncology, Department of Surgery, Loyola University Medical Center, 2160 South 1st Avenue, Maywood, IL, USA;Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI 53226, USA

关键词: laparoscopy;    staging;    HIPEC;    surgical procedures;    postoperative complications;    chemotherapy;    regional perfusion;    Peritoneal neoplasms;   

Others  :  1148204
DOI  :  10.1186/1477-7819-12-270

 received in 2014-05-13, accepted in 2014-07-20,  发布年份 2014

【 摘 要 】

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.

【 授权许可】

   
2014 Jayakrishnan et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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