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The role of single-incision laparoscopic peritoneal exploration in the management of patients with peritoneal metastases.
Surgical Endoscopy ( IF 3.1 ) Pub Date : 2019-07-18 , DOI: 10.1007/s00464-019-06984-8
Haythem Najah 1, 2 , Brice Malgras 1, 2 , Anthony Dohan 2, 3 , Caroline Gronnier 4 , Clarisse Eveno 1, 2 , Marc Pocard 1, 2
Affiliation  

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.

中文翻译:

单切口腹腔镜腹膜探查在腹膜转移患者管理中的作用。

背景技术细胞减灭术和腹膜内高温化疗(CRS / HIPEC)的结果取决于腹膜转移(PM)的程度和细胞减少(CCR)的完整性。术前评估PM的作用是确定潜在的CRS / HIPEC候选者,并为那些没有选择的人进行不必要的剖腹手术。腹腔镜检查已用于该目的,但与技术难题和套管针部位转移的风险有关。在这种情况下,尚未对单切口腹腔镜腹膜探查术(SILPE)进行评估。方法这项单中心回顾性研究检查了2011年1月至2015年12月接受SILPE诊断和分期的PM患者。收集术前,术中和术后数据。对于随后进行剖腹手术的患者,比较了SILPE和剖腹手术的发现。结果总共进行了183次SILPE。原发部位主要是结直肠癌72例(39.3%),胃癌47例(25.7%)。总体而言,有157例患者(85.8%)曾接受过至少一次腹部手术,而48例(26.2%)有3例或更多。SILPE成功案例达到90.2%。观察到两个(1.2%)术中并发症和五个(3%)术后并发症。八十一例患者接受了剖腹手术,从SILPE到剖腹手术之间的中位数为27天(4-162天)。腹膜癌的PCI指数在SILPE时为9.7±7.5,在剖腹手术时为13.5±9.6。SILPE预测CCR的阳性预测值为79.5%。SILPE敏感性为75%,特异性为97%。最低的灵敏度在9-12区,范围从44%到53%。结论SILPE可以安全地纳入PM患者的管理中。这是一种安全可行的分期工具,可以防止未被认为是CRS / HIPEC候选者的患者进行不必要的剖腹手术。即使可能低估了PCI,SILPE仍可以准确预测CCR的可能性。
更新日期:2020-04-22
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