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Laparoscopic Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy (L-CRS/HIPEC) for Perforated Low-Grade Appendiceal Mucinous Neoplasm (LAMN II)

  • Ed Parkin
  • Chelliah Selvasekar
  • Malcolm Wilson
  • Andrew Renehan
  • Sarah O’Dwyer
  • Omer AzizEmail author
Open Access
Peritoneal Surface Malignancy

Abstract

Introduction

Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is an established treatment for pseudomyxoma peritonei resulting from a perforated low-grade appendiceal mucinous neoplasm (LAMN II). In patients with localized disease, a laparoscopic procedure (L-CRS/HIPEC) can be undertaken.

Methods

This video demonstrates L-CRS/HIPEC in a 66-year-old male who had previously undergone an appendicectomy for an LAMN II lesion. The preoperative computed tomography (CT) scan suggested disease localized to the right iliac fossa. However, laparoscopic assessment unexpectedly revealed disease in the pelvis and on the right hemidiaphragm and liver surface.

Results

A technique for treating the thin film of mucin in the pelvis and on the right hemidiaphragm is demonstrated. The liver is mobilized to facilitate ablation of mucin on the serosal surface of the right lobe. Tips and tricks for starting the omentectomy, dealing with the vascular pedicle, and completing the dissection in the left upper quadrant are shown. The Peritoneal Cancer Index (PCI) score was 5 (3 for the right upper quadrant, 1 for the pelvis, 1 for the small bowel), and the cytoreduction score was CC-1. The operative duration was 8.5 h, and length of hospital stay was 5 days. The patient returned to work after 6 weeks.

Discussion

L-CRS/HIPEC can be performed when patients are unexpectedly found to have disease, provided the appendiceal pathology is low grade and the PCI score is low. There are potential benefits to this approach, with a shorter length of hospital stay and faster functional recovery when compared with traditional open surgery.

Notes

Supplementary material

Supplementary material 1 (MP4 299027 kb)

Copyright information

© The Author(s) 2019

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

Authors and Affiliations

  • Ed Parkin
    • 1
    • 2
  • Chelliah Selvasekar
    • 1
    • 2
  • Malcolm Wilson
    • 1
    • 2
  • Andrew Renehan
    • 1
    • 2
  • Sarah O’Dwyer
    • 1
    • 2
  • Omer Aziz
    • 1
    • 2
    Email author
  1. 1.The Christie NHS Foundation Trust, Colorectal and Peritoneal Oncology CentreManchesterUK
  2. 2.Manchester Cancer Research CentreUniversity of ManchesterManchesterUK

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