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

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Abstract

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.

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Authors and Affiliations

  1. Department of Oncologic & Digestive Surgery, AP-HP, Hospital Lariboisière, 2 Rue Ambroise Paré, 75475, Paris Cedex 10, France

    Haythem Najah, Brice Malgras, Clarisse Eveno & Marc Pocard

  2. Université Paris Diderot, Sorbonne Paris Cité, CART, INSERM U965, 74575, Paris, France

    Haythem Najah, Brice Malgras, Anthony Dohan, Clarisse Eveno & Marc Pocard

  3. Department of Abdominal Imaging, Hôpital Lariboisière-AP-HP, 2 Rue Ambroise Paré, 75475, Paris Cedex 10, France

    Anthony Dohan

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

    Caroline Gronnier

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  1. Haythem Najah
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  2. Brice Malgras
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Correspondence to Haythem Najah.

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Disclosures

Fujifilm Medical System Company has lent the INSERM 965 Research Unit (attached to the department of Surgery of Lariboisière Hospital) a gastroscope and a FICE system in order to study the contribution of virtual chromoendoscopy to detect peritoneal carcinomatosis in animal model. Drs. Haythem Najah and Marc Pocard had recently filed a patent via INSERMTransfert in Europe and in the USA. Drs. Brice Malgras, Anthony Dohan, Caroline Gronnier, and Clarisse Eveno have no conflicts of interest or financial ties to disclose.

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Najah, H., Malgras, B., Dohan, A. et al. The role of single-incision laparoscopic peritoneal exploration in the management of patients with peritoneal metastases. Surg Endosc 34, 2040–2049 (2020). https://doi.org/10.1007/s00464-019-06984-8

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