Diagnostic Laparoscopy for the Evaluation of Peritoneal Metastases

Chapter

Abstract

Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are accepted as a curative treatment option for selected patients with peritoneal metastases (PM) arising from various primary sites. The two most significant prognostic factors determining the outcomes in these patients are the extent of the disease quantified by the peritoneal cancer index (PCI) and the completeness of tumor removal as determined by the completeness of cytoreduction score (CC score). Appropriate patient selection is the key to obtaining optimal results and limiting the morbidity of this procedure. Current imaging modalities which form the cornerstone of evaluating patients for this therapy have limitations in accurately predicting tumor spread in certain areas of the peritoneal cavity and are also limited in their ability to detect small-sized tumor nodules. Diagnostic video laparoscopy (DVL) that allows direct visualization of the visceral and peritoneal surfaces is a useful adjunct to imaging modalities in selecting patients by predicting the extent of disease and the possibility of a complete cytoreduction. Though laparoscopy may be limited in some cases due to the presence of adhesions or extensive disease, in others it is easy to perform with minimal morbidity and hospital stay and has a high positive predictive value. Multiple procedures can be performed especially in patients who have had neoadjuvant therapies where both a morphologic and pathological response to therapy can be assessed. The role of laparoscopy in the management of PM has been further enhanced by introduction of new treatments like pressurized intraperitoneal aerosol chemotherapy (PIPAC) where it is used for both diagnosis and treatment delivery. Moreover, in selected patients, CRS and/or HIPEC is being performed laparoscopically.

Keywords

Peritoneal metastases Peritoneal carcinomatosis Diagnostic laparoscopy Diagnostic video laparoscopy Laparoscopic staging 

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© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  1. 1.Department of General and Oncological Surgery (Surgery-C)The Chaim Sheba Medical CenterTel HashomerIsrael

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