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Laparoscopy as a useful selection tool for patients with prior surgery and peritoneal metastases suitable for multimodality treatment strategies

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Abstract

Background

Complete macroscopic cytoreduction in patients with peritoneal carcinomatosis (PC) is the basic requirement for long-term survival. Diagnostic laparoscopy (DL) can be difficult and of limited clinical value secondary to postoperative or tumor-induced adhesions. The aim of this study was to evaluate the role of DL in patients with prior surgery and PC.

Methods

The database of the surgical department of the University Medical Center of Regensburg was reviewed (9/2010–10/2014) selecting for DL in patients with PC. The operative report had a standardized format allowing for the determination of the extent of the intra-abdominal visible area and the extent of tumor on the surface of the small intestine. For the classification we used our own developed score.

Results

DL was performed in 102 patients. The complete abdominal cavity was evaluable in 48%. At least two quadrants and the largest part of the small intestine could be assessed in 70%. 37% of the patients had massive tumor manifestation on the small intestine or its mesentery. PCI (Peritoneal Cancer Index) could not be calculated in 71% of the patients due to incomplete visualization of the abdominal cavity and/or multiple tumor manifestations on the small intestine. 54% of patients were classified as non-resectable and 85% who seemed suitable for cytoreductive surgery underwent a CCR-0 resection and HIPEC.

Conclusions

In spite of prior surgery and PC, DL is frequently possible and a useful tool to define the extent of tumor spread. Lots of patients can be prevented from needless open laparotomy. The extent of tumor involvement of the small intestine seems to be more relevant than calculation of the PCI to determine the potential for complete resection. Therefore, in the presence of adhesions, inspection of the complete abdominal cavity does not offer added clinical benefit and further adhesiolysis can be avoided.

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Authors and Affiliations

  1. Department of Surgery, University of Regensburg Medical Center, Regensburg, Germany

    Philipp von Breitenbuch, Thomas Boerner & Hans J. Schlitt

  2. Department of Surgery, Krankenhaus der Barmherzigen Brüder, Regensburg, Germany

    Tonia Jeiter & Pompiliu Piso

  3. Department of Surgery, Elblandklinikum Radebeul, Heinrich-Zille-Strasse 13, 01445, Radebeul, Germany

    Philipp von Breitenbuch

Authors
  1. Philipp von Breitenbuch
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  2. Thomas Boerner
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  4. Pompiliu Piso
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  5. Hans J. Schlitt
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Correspondence to Philipp von Breitenbuch.

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Disclosures

Drs. Philipp von Breitenbuch, Thomas Boerner, Tonia Jeiter, Pompiliu Piso, and Hans J. Schlitt have no conflicts of interest or financial ties to disclose.

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von Breitenbuch, P., Boerner, T., Jeiter, T. et al. Laparoscopy as a useful selection tool for patients with prior surgery and peritoneal metastases suitable for multimodality treatment strategies. Surg Endosc 32, 2288–2294 (2018). https://doi.org/10.1007/s00464-017-5923-0

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  • DOI: https://doi.org/10.1007/s00464-017-5923-0

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