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

Laparoendoscopic single-site surgery Minimally invasive surgery Peritoneal cancer index Peritoneal carcinomatosis Peritoneoscopy Single-incision laparoscopic surgery

Journal

Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653

Informations de publication

Date de publication:
05 2020
Historique:
received: 20 11 2018
accepted: 15 07 2019
pubmed: 20 7 2019
medline: 29 5 2021
entrez: 20 7 2019
Statut: ppublish

Résumé

The outcome of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) depends on the extent of peritoneal metastases (PM) and the completeness of cytoreduction (CCR). The role of preoperative assessment of PM is to identify potential candidates for CRS/HIPEC and to prevent unwarranted laparotomy for those who are not. Laparoscopy has been utilized for that purpose but with concerns related to technical difficulties and risk of trocar site metastases. Single-incision laparoscopic peritoneal exploration (SILPE) has not yet been evaluated in this setting. This single-center retrospective study examined patients from January 2011 to December 2015 who underwent SILPE for diagnosis and staging of PM. Preoperative, intraoperative, and postoperative data were collected. For the patients who underwent subsequent laparotomy, a comparison between SILPE and laparotomy findings was made. A total of 183 SILPE were performed. Primary sites were mostly colorectal in 72 cases (39.3%) and gastric in 47 (25.7%). Overall, 157 patients (85.8%) had at least one prior abdominal surgery and 48 (26.2%) had 3 or more. SILPE was successfully achieved in 90.2% of the cases. Two (1.2%) intraoperative complications and five (3%) postoperative complications were observed. Eighty-one patients had laparotomy, with a median of 27 days between SILPE and laparotomy (4-162 days). The peritoneal carcinomatosis index PCI was 9.7 ± 7.5 at SILPE, and 13.5 ± 9.6 at laparotomy. The positive predictive value of SILPE to predict CCR was 79.5%. SILPE sensitivity was 75% and specificity 97%. The lowest sensitivity was in regions 9-12 ranging from 44 to 53%. SILPE can be safely incorporated in the management of patients with PM. It is a safe and feasible staging tool, allowing for preventing unwarranted laparotomy for patients not deemed candidate for CRS/HIPEC. Even though it may underestimate PCI, SILPE accurately predicts the possibility of CCR.

Sections du résumé

BACKGROUND
The outcome of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) depends on the extent of peritoneal metastases (PM) and the completeness of cytoreduction (CCR). The role of preoperative assessment of PM is to identify potential candidates for CRS/HIPEC and to prevent unwarranted laparotomy for those who are not. Laparoscopy has been utilized for that purpose but with concerns related to technical difficulties and risk of trocar site metastases. Single-incision laparoscopic peritoneal exploration (SILPE) has not yet been evaluated in this setting.
METHODS
This single-center retrospective study examined patients from January 2011 to December 2015 who underwent SILPE for diagnosis and staging of PM. Preoperative, intraoperative, and postoperative data were collected. For the patients who underwent subsequent laparotomy, a comparison between SILPE and laparotomy findings was made.
RESULTS
A total of 183 SILPE were performed. Primary sites were mostly colorectal in 72 cases (39.3%) and gastric in 47 (25.7%). Overall, 157 patients (85.8%) had at least one prior abdominal surgery and 48 (26.2%) had 3 or more. SILPE was successfully achieved in 90.2% of the cases. Two (1.2%) intraoperative complications and five (3%) postoperative complications were observed. Eighty-one patients had laparotomy, with a median of 27 days between SILPE and laparotomy (4-162 days). The peritoneal carcinomatosis index PCI was 9.7 ± 7.5 at SILPE, and 13.5 ± 9.6 at laparotomy. The positive predictive value of SILPE to predict CCR was 79.5%. SILPE sensitivity was 75% and specificity 97%. The lowest sensitivity was in regions 9-12 ranging from 44 to 53%.
CONCLUSION
SILPE can be safely incorporated in the management of patients with PM. It is a safe and feasible staging tool, allowing for preventing unwarranted laparotomy for patients not deemed candidate for CRS/HIPEC. Even though it may underestimate PCI, SILPE accurately predicts the possibility of CCR.

Identifiants

pubmed: 31321535
doi: 10.1007/s00464-019-06984-8
pii: 10.1007/s00464-019-06984-8
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

2040-2049

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Auteurs

Haythem Najah (H)

Department of Oncologic & Digestive Surgery, AP-HP, Hospital Lariboisière, 2 Rue Ambroise Paré, 75475, Paris Cedex 10, France. haythem.najah@gmail.com.
Université Paris Diderot, Sorbonne Paris Cité, CART, INSERM U965, 74575, Paris, France. haythem.najah@gmail.com.

Brice Malgras (B)

Department of Oncologic & Digestive Surgery, AP-HP, Hospital Lariboisière, 2 Rue Ambroise Paré, 75475, Paris Cedex 10, France.
Université Paris Diderot, Sorbonne Paris Cité, CART, INSERM U965, 74575, Paris, France.

Anthony Dohan (A)

Université Paris Diderot, Sorbonne Paris Cité, CART, INSERM U965, 74575, Paris, France.
Department of Abdominal Imaging, Hôpital Lariboisière-AP-HP, 2 Rue Ambroise Paré, 75475, Paris Cedex 10, France.

Caroline Gronnier (C)

Department of Digestive and Endocrine Surgery, Bordeaux University Hospital, Hôpital Haut lévêque, Centre Magellan, 33604, Pessac Cedex, France.

Clarisse Eveno (C)

Department of Oncologic & Digestive Surgery, AP-HP, Hospital Lariboisière, 2 Rue Ambroise Paré, 75475, Paris Cedex 10, France.
Université Paris Diderot, Sorbonne Paris Cité, CART, INSERM U965, 74575, Paris, France.

Marc Pocard (M)

Department of Oncologic & Digestive Surgery, AP-HP, Hospital Lariboisière, 2 Rue Ambroise Paré, 75475, Paris Cedex 10, France.
Université Paris Diderot, Sorbonne Paris Cité, CART, INSERM U965, 74575, Paris, France.

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