Limitations of laparoscopy to assess the peritoneal cancer index and eligibility for cytoreductive surgery with HIPEC in peritoneal metastasis

Can Yurttas,Giorgi Nadiradze,Philipp Horvath,Alfred Königsrainer,Lisa Überrück

doi:10.1007/s00423-022-02455-2

Can Yurttas, Giorgi Nadiradze + Show 3 more

Open Access

https://doi.org/10.1007/s00423-022-02455-2

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Abstract

PurposeWe aimed to determine the value of laparoscopy to assess the intra-abdominal tumor extent and predict complete cytoreduction.MethodsAll patients at our department in the period from 2017 to 2021 that underwent laparoscopy to assess peritoneal metastasis and subsequent open exploration with the intention to perform cytoreductive surgery (CRS) with HIPEC were retrospectively identified in a continuously maintained database.ResultsForty-three patients were analyzed. Peritoneal cancer index (PCI) determination by laparoscopy compared to open surgery was overestimated in five patients (11.6%), identical in eleven patients (25.6%), and underestimated in 27 patients (62.8%). PCI differences were independent of surgeons, tumor entities, and prior chemotherapy. Thirty-four patients (79.1%) were determined eligible for CRS with HIPEC during open exploration, whereas nine patients (20.9%) underwent a non-therapeutic laparotomy. Complete or almost complete cytoreduction was achieved in 33 patients (76.7%). In one patient, completeness of cytoreduction was not documented.ConclusionsWe demonstrate a moderate agreement according to weighted Cohen’s kappa analysis of PCI values calculated during laparoscopy and subsequent open exploration for CRS with HIPEC. Uncertainty of PCI assessment should therefore be kept in mind when performing laparoscopy in patients with peritoneal metastasis.

Highlights

Peritoneal metastasis (PM) comprises primary tumors of the peritoneum as well as peritoneal seedings from other solid tumor sites
We retrospectively identified 19 women (44.2%) and 24 men (55.8%) between the age of 27 and 83 in a continuously maintained database that first underwent laparoscopic exploration for suspected PM and were assessed eligible for complete cytoreduction
All 43 included patients were subjected to exploratory laparotomy with the intention to perform cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC)

Summary

Introduction

Peritoneal metastasis (PM) comprises primary tumors of the peritoneum as well as peritoneal seedings from other solid tumor sites. The technique of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has been established for the treatment of selected patients with PM This combined treatment includes peritonectomy and visceral organ resection aiming to completely remove abdominal and pelvic tumor formations. HIPEC is performed to eliminate remaining tumor and free peritoneal tumor cells For certain entities, such as pseudomyxoma peritonei and malignant peritoneal mesothelioma, combination therapy of CRS and HIPEC became the standard of care [1, 2]. Many authors advocated this form of therapy as a standard of care for PM of the ovary [3], colorectal tumors and tumors of the appendix [1, 4, 5] The preconditions for this form of therapy are the absence of extra-abdominal metastases, limited PM depending on the tumor entity, and macroscopically complete tumor removal.

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