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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 4/2020

Open Access 01-04-2020 | Laparotomy | Gastrointestinal Oncology

Diagnostic Laparoscopy as a Selection Tool for Patients with Colorectal Peritoneal Metastases to Prevent a Non-therapeutic Laparotomy During Cytoreductive Surgery

Authors: Judith E. K. R. Hentzen, MD, Reickly D. N. Constansia, MD, Lukas B. Been, MD, PhD, Frederik J. H. Hoogwater, MD, PhD, Robert J. van Ginkel, MD, PhD, Gooitzen M. van Dam, MD, PhD, Patrick H. J. Hemmer, MD, Schelto Kruijff, MD, PhD

Published in: Annals of Surgical Oncology | Issue 4/2020

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Abstract

Objective

The aim of this study was to evaluate the introduction of diagnostic laparoscopy (DLS) in patients with colorectal peritoneal metastases (PM) to prevent non-therapeutic laparotomies during cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS + HIPEC).

Methods

Patients with histologically proven colorectal PM who underwent a laparotomy for potential CRS + HIPEC from January 2006 to January 2019 were retrospectively identified from a prospectively maintained database. In 2012, DLS was introduced in the preoperative work-up for CRS + HIPEC in our academic center. The rates of non-therapeutic laparotomies, major postoperative complications (Clavien–Dindo grade III or higher), and survival outcomes were investigated for patients who underwent a laparotomy before (cohort A) and after (cohort B) the introduction of DLS. In cohort B, the reasons to refrain from DLS were retrospectively explored from medical records.

Results

Overall, 172 patients were included [cohort A: 48 patients (27.9%); cohort B: 124 patients (72.1%)]. A significant drop in the rate of non-therapeutic laparotomies occurred in cohort B compared with cohort A (21.0 vs. 35.4%: p = 0.044), despite only 85 patients (68.5%) from cohort B undergoing DLS in our academic center. The most important reason to refrain from DLS was a recently performed DLS or laparotomy in the referring hospital (48.7%). Major postoperative complications, in-hospital mortality, and survival outcomes were similar for both cohorts.

Conclusions

Performing DLS during the preoperative work-up for CRS + HIPEC prevents non-therapeutic laparotomies in patients with colorectal PM. We recommend performing this laparoscopic screening in an experienced HIPEC center.
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Metadata
Title
Diagnostic Laparoscopy as a Selection Tool for Patients with Colorectal Peritoneal Metastases to Prevent a Non-therapeutic Laparotomy During Cytoreductive Surgery
Authors
Judith E. K. R. Hentzen, MD
Reickly D. N. Constansia, MD
Lukas B. Been, MD, PhD
Frederik J. H. Hoogwater, MD, PhD
Robert J. van Ginkel, MD, PhD
Gooitzen M. van Dam, MD, PhD
Patrick H. J. Hemmer, MD
Schelto Kruijff, MD, PhD
Publication date
01-04-2020
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 4/2020
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-019-07957-w

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