Abstract
Background
In light of the modern surgical trend towards minimally invasive surgery, we aim to assess the feasibility of hand-assisted laparoscopic (HAL) cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in peritoneal surface malignancy (PSM).
Methods
Patients with PSM secondary to colorectal cancer or pseudomyxoma peritonei with peritoneal cancer index (PCI) of ≤ 10 were considered for HAL CRS and HIPEC. One patient had PCI of 15 but based on the disease distribution laparoscopic-assisted CRS and HIPEC was thought to be feasible, thus was also included. These patients were compared to matched controls who underwent open CRS and HIPEC for similar pathologies. Matching was performed on age and PCI to reflect a comparable complexity of the operation, and tumor grade for comparable risk of disease recurrence.
Results
Eleven patients were included in each group. In both groups, mean PCI was 4.1, mean age was 58.5 years, and 81.8% were well-moderately differentiated tumors. Complete cytoreduction was achieved in all patients. Upon comparison, HAL patients had significantly less blood loss and 3-day shorter hospitalization. No difference was demonstrated in operative time, number of visceral resections, and rate of omentectomy/peritonectomy. Also, no difference was detected in morbidities and 30-day readmission rates. No intraperitoneal recurrences have been reported in the HAL group after a median follow-up of 11 months.
Conclusion
HAL CRS and HIPEC is a feasible procedure and can be considered for PSM with low PCI. It offers very acceptable and comparable short-term outcomes to the conventional open approach.
Similar content being viewed by others
References
Esquivel J, Averbach A, Chua TC (2011) Laparoscopic cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients with limited peritoneal surface malignancies: feasibility, morbidity and outcome in an early experience. Ann Surg 253(4):764–768
Salti GI, Ailabouni L, Undevia S (2012) Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for the treatment of peritoneal sarcomatosis. Ann Surg Oncol 19(5):1410–1415
Jacquet P, Sugarbaker PH (1996) Clinical research methodologies in diagnosis and staging of patients with peritoneal carcinomatosis. Cancer Treat Res 82:359–374
Clavien PA, Barkun J, de Oliveira ML et al (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196
Schlachta CM, Mamazza J, Seshadri PA et al (2001) Defining a learning curve for laparoscopic colorectal resections. Dis Colon Rectum 44(2):217–222
Bennett CL, Stryker SJ, Ferreira MR et al (1997) The learning curve for laparoscopic colorectal surgery: preliminary results from a prospective analysis of 1194 laparoscopic-assisted colectomies. Arch Surg 132(1):41–44 (discussion 5).
Tekkis PP, Senagore AJ, Delaney CP, Fazio VW (2005) Evaluation of the learning curve in laparoscopic colorectal surgery: comparison of right-sided and left-sided resections. Ann Surg 242(1):83–91
Ozturk E, da Luz Moreira A, Vogel JD (2010) Hand-assisted laparoscopic colectomy: the learning curve is for operative speed, not for quality. Colorectal Dis 12(10 Online):e304-9
Corrado G, Mancini E, Cutillo G et al (2015) Laparoscopic debulking surgery in the management of advanced ovarian cancer after neoadjuvant chemotherapy. Int J Gynecol Cancer 25(7):1253–1257
Melamed A, Keating NL, Clemmer JT et al (2017) Laparoscopic staging for apparent stage I epithelial ovarian cancer. Am J Obstet Gynecol 216(1):50e1–50e12.
Varnoux C, Huchon C, Bats AS et al (2013) Diagnostic accuracy of hand-assisted laparoscopy in predicting resectability of peritoneal carcinomatosis from gynecological malignancies. Eur J Surg Oncol 39(7):774–779
Stein S, Whelan RL (2007) The controversy regarding hand-assisted colorectal resection. Surg Endosc 21(12):2123–2126
Orenstein SB, Elliott HL, Reines LA, Novitsky YW (2011) Advantages of the hand-assisted versus the open approach to elective colectomies. Surg Endosc 25(5):1364–1368
Chang YJ, Marcello PW, Rusin LC et al (2005) Hand-assisted laparoscopic sigmoid colectomy: helping hand or hindrance? Surg Endosc 19(5):656–661
Valle SJ, Alzahrani NA, Alzahrani SE et al (2015) Laparoscopic hyperthermic intraperitoneal chemotherapy (HIPEC) for refractory malignant ascites in patients unsuitable for cytoreductive surgery. Int J Surg 23(Pt A):176–180
Badgwell B, Blum M, Das P et al (2017) Phase II trial of laparoscopic hyperthermic intraperitoneal chemoperfusion for peritoneal carcinomatosis or positive peritoneal cytology in patients with gastric adenocarcinoma. Ann Surg Oncol 24:3338–3344
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Dr. George I. Salti and Dr. Samer A. Naffouje have no conflicts of interest or financial ties to disclose.
Rights and permissions
About this article
Cite this article
Salti, G.I., Naffouje, S.A. Feasibility of hand-assisted laparoscopic cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal surface malignancy. Surg Endosc 33, 52–57 (2019). https://doi.org/10.1007/s00464-018-6265-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-018-6265-2