Background

Cytoreductive surgery (CRS) for colorectal cancer peritoneal carcinomatosis has been shown to prolong survival with acceptable morbidity rates. Total pelvic peritonectomy (TPP), or complete removal of all pelvic peritoneum, constitutes an important and technically challenging component of CRS. Here we report our experience and describe our technique of laparoscopic total pelvic peritonectomy (LTPP), using a photographic/videographic step-by-step guide.

Methods

All patients who underwent LTPP for pelvic carcinomatosis from a colorectal origin were included in the study. Only patients with peritoneal cancer index (PCI) score of ≤ 10 were selected for CRS with LTPP. Patients who had extra-abdominopelvic cavity metastases were excluded. The final decision to proceed with CRS was made following laparoscopic assessment.

Results

From January 2017 to December 2020, 15 consecutive patients underwent LTPP for colorectal cancer pelvic carcinomatosis. Median patient age and PCI score was 53 years (range 33–78) and 8 (range 3–10), respectively. Complete cytoreduction was achieved in all patients. Thirteen patients (87%) underwent concomitant hyperthermic intraperitoneal chemotherapy (HIPEC). The median operative duration was 748 min (interquartile range [IQR] 681–850). Median intra-operative blood loss and length of hospital stay was 100 ml (IQR 50–300) and 10 days (IQR 8–12), respectively. Five patients (33%) experienced 30-day post-operative morbidity, with one (6.7%) experiencing a higher grade (Clavien–Dindo IIIa) complication. Median follow-up duration was 13 months (IQR 3–19), during which four (27%) had systemic recurrence and one (6.7%) died after 15 months following peritoneal and systemic recurrences.

Conclusion

LTPP is a feasible option for low-volume pelvic carcinomatosis from colorectal cancer, offering the benefits of a minimally invasive approach. Strict patient selection is essential, and the procedure should be converted if the PCI score cannot be assessed or complete cytoreduction cannot be achieved. Proficiency at laparoscopic pelvic surgery is mandatory for performing LTPP.

中文翻译：

---

腹腔镜全盆腔腹膜切除术治疗结直肠癌盆腔癌：回顾性病例系列和摄影/录像分步指南

背景

大肠癌腹膜癌病的减细胞手术 (CRS) 已被证明可延长生存期，且发病率可接受。全盆腔腹膜切除术 (TPP) 或完全切除所有盆腔腹膜是 CRS 的一个重要且技术上具有挑战性的组成部分。在这里，我们报告我们的经验并描述我们的腹腔镜全盆腔腹膜切除术 (LTPP) 技术，使用摄影/视频分步指南。

方法

所有因结直肠来源的盆腔癌接受 LTPP 的患者均被纳入研究。只有腹膜癌指数 (PCI) 评分≤10 的患者被选择接受 LTPP 的 CRS。有腹盆腔外转移的患者被排除在外。进行 CRS 的最终决定是在腹腔镜评估后做出的。

结果

从 2017 年 1 月到 2020 年 12 月，连续 15 名患者接受了 LTPP 治疗结直肠癌盆腔癌。中位患者年龄和 PCI 评分分别为 53 岁（范围 33-78）和 8 岁（范围 3-10）。所有患者均实现了完全的细胞减灭术。13 名患者 (87%) 接受了伴随腹腔内热疗 (HIPEC)。中位手术时间为 748 分钟（四分位距 [IQR] 681-850）。中位术中失血量和住院时间分别为 100 毫升（IQR 50-300）和 10 天（IQR 8-12）。5 名患者 (33%) 术后 30 天出现并发症，其中 1 名 (6.7%) 出现更严重的并发症 (Clavien-Dindo IIIa)。中位随访时间为 13 个月 (IQR 3-19)，其中 4 例 (27%) 出现全身性复发，1 例 (6.

结论

LTPP 是治疗结直肠癌小体积盆腔癌的可行选择，具有微创方法的优势。严格的患者选择至关重要，如果无法评估 PCI 评分或无法实现完全的细胞减灭术，则应转换程序。执行 LTPP 必须精通腹腔镜盆腔手术。