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A minimally invasive approach for peritonectomy procedures and hyperthermic intraperitoneal chemotherapy (HIPEC) in limited peritoneal carcinomatosis: The American Society of Peritoneal Surface Malignancies (ASPSM) multi-institution analysis

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Abstract

Background

Minimally invasive surgery is playing an increasing role in the treatment of patients with gastrointestinal and gynaecological malignancies as the data show reduced morbidity, faster recovery and similar oncological outcome when compared to open procedures.

Materials and methods

The American Society of Peritoneal Surface Malignancies (ASPSM) conducted a retrospective study to analyse peritonectomy procedures and HIPEC done via the laparoscopic route. A database with standard clinical and pathological parameters was set up and distributed amongst ASPSM members. Rate of relapse, morbidity and mortality were the primary endpoints of the study.

Results

A total of 90 patients from 7 centres around the world were identified. Sixty percent were female. Mean age was 50 years. Peritoneal carcinomatosis from appendiceal origin was the most common diagnosis in a 64.9% of patients and colon origin was diagnosed in 16.5% of patients. Mean peritoneal cancer index (PCI) was 4.1 (0–10). Forty-one percent of patients had a bowel resection. Mean operative time was 4.7 h (2.5–8). All patients had a complete cytoreduction and HIPEC. Grade 3 and 4 morbidity was 3.0 and 6.5%, respectively. The most common reason for re-operation was an internal hernia in 2 out of 5 cases. Operative mortality and re-admission rates were 0 and 5%, respectively. Mean hospital stay was 7.4 days (1–18). At a mean follow-up of 31.6 months, 15/90 patients have a disease relapse but loco-regional relapse was identified in only five patients.

Conclusions

Analysis of these data suggests that minimally invasive approach for peritonectomy procedures and HIPEC is feasible, safe and should be considered as part of the armamentarium for highly selected patients with peritoneal surface malignancies with limited tumour burden, defined as PCI of 10 or less and borderline tumours as low-grade pseudomyxoma and benign multicystic mesothelioma.

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Authors and Affiliations

  1. Unit of Surgical Oncology, Department of Surgery and CIBERehd, IMIBIC, University Hospital Reina Sofia, Cordova, Spain

    A. Arjona-Sanchez & S. Rufian-Peña

  2. Department of Surgical Oncology, Frederick Memorial Hospital, 7211 Bank Court, Suite 200, Frederick, MD, USA

    J. Esquivel

  3. Department of Surgical Oncology, Centre Hospitalier Lyon-Sud, Pierre-Benite, France

    O. Glehen & G. Passot

  4. Section of General Surgery and Surgical Oncology, The University of Chicago Medicine, Chicago, IL, USA

    K. K. Turaga

  5. Division of Surgical Oncology, Department of Surgery, Mount Sinai Medical Center, New York, NY, USA

    D. Labow

  6. Unit of Surgical Oncology, Hospital son Spaces, Palma de Mallorca, Spain

    R. Morales

  7. Department of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium

    K. van der Speeten

Authors
  1. A. Arjona-Sanchez
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  2. J. Esquivel
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  3. O. Glehen
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  4. G. Passot
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  7. S. Rufian-Peña
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Corresponding author

Correspondence to J. Esquivel.

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Disclosures

Drs A. Arjona-Sanchez, J. Esquivel, O. Glehen, G. Passot, K. K. Turaga, D. Labow, S. Rufian-Peña, R. Morales and K. van der Speeten have no conflicts of interest or financial ties to disclose.

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Arjona-Sanchez, A., Esquivel, J., Glehen, O. et al. A minimally invasive approach for peritonectomy procedures and hyperthermic intraperitoneal chemotherapy (HIPEC) in limited peritoneal carcinomatosis: The American Society of Peritoneal Surface Malignancies (ASPSM) multi-institution analysis. Surg Endosc 33, 854–860 (2019). https://doi.org/10.1007/s00464-018-6352-4

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