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Inadvertent laparoscopic lavage of perforated colon cancer: a systematic review

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Abstract

Background

Although laparoscopic lavage for perforated diverticulitis with peritonitis has been grabbing the headlines, it is known that the clinical presentation of peritonitis can also be caused by an underlying perforated carcinoma. The aim of this study was to determine the incidence of patients undergoing inadvertent laparoscopic lavage of perforated colon cancer as well as the delay in cancer diagnosis.

Methods

The PubMed database was systematically searched to include all studies meeting inclusion criteria. Studies were screened through titles and abstracts with potentially eligible studies undergoing full-text screening. The primary endpoints of this meta-analysis were the rates of perforated colon cancer patients having undergone inadvertent laparoscopic lavage as well as the delay in cancer diagnosis. This was expressed in pooled rate % and 95% confidence intervals.

Results

Eleven studies (three randomized, two prospective, six retrospective) totaling 642 patients met inclusion criteria. Eight studies reported how patients were screened for cancer and the number of patients who completed follow-up. The pooled cancer rate was 3.4% (0.9%, 5.8%) with low heterogeneity (Isquare2 = 34.02%) in eight studies. Cancer rates were 8.2% (0%, 3%) (Isquare2 = 58.2%) and 1.7% (0%, 4.5%) (Isquare2 = 0%) in prospective and retrospective studies, respectively. Randomized trials reported a cancer rate of 7.2% (3.1%, 11.2%) with low among-study heterogeneity (Isquare2 = 0%) and a median delay to diagnosis of 2 (1.5–5) months.

Conclusions

This systematic review found that 7% of patients undergoing laparoscopic lavage for peritonitis had perforated colon cancer with a delay to diagnosis of up to 5 months.

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Data availability

Data are available upon request.

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Authors and Affiliations

  1. Department of Surgery, Jacobi Medical Center, New York City Health Hospitals, Building 1, Suite 610, 1400 Pelham Parkway S, New York, NY, USA

    Mahir Gachabayov, Agon Kajmolli, Luis Quintero & Roberto Bergamaschi

  2. Division of Visceral Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria

    Daniel M. Felsenreich

  3. Department of General Surgery, Linkö** University Hospital, Linkö**, Sweden

    Dorin E. Popa

  4. Department of Digestive Surgery, Akershus University Hospital, University of Oslo, Lorenskog, Norway

    Dejan Ignjatovic

  5. Department of Surgery, New York Medical College, Valhalla, NY, USA

    Mahir Gachabayov, Agon Kajmolli & Luis Quintero

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  1. Mahir Gachabayov
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  7. Roberto Bergamaschi
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Contributions

Study conception and design: MG, RB Acquisition of data: MG, AK, LQ, DMF Analysis and interpretation of data: MG, AK, LQ, DMF, DEP, DI, RB Drafting of the manuscript: MG, DMF, RB Critical revision of manuscript: MG, AK, LQ, DMF, DEP, DI, RB.

Corresponding author

Correspondence to Roberto Bergamaschi.

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The authors declare no competing interests.

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Authors have no conflicts of interests.

Presentations

This study was accepted for poster presentation at the Annual Scientific Meeting of the American Society of Colon and Rectal Surgeons, April 30 – May 4, 2022, Tampa, FL.

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Gachabayov, M., Kajmolli, A., Quintero, L. et al. Inadvertent laparoscopic lavage of perforated colon cancer: a systematic review. Langenbecks Arch Surg 409, 35 (2024). https://doi.org/10.1007/s00423-023-03224-5

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