Top

Surgical Endoscopy

Published in:

01-06-2020 | Laparoscopy | Dynamic Manuscript

Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy by laparoscopy via a single-port approach for low-grade peritoneal malignancy

Authors: F. Dumont, E. Duchalais, A. Aumont, E. Thibaudeau

Published in: Surgical Endoscopy | Issue 6/2020

Abstract

Background

Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is a long and complex procedure. A minimal invasive approach is rarely performed. The feasibility of laparoscopic CRS and HIPEC via a single port (SP) approach is unknown. The aim of this study was to assess the feasibility of CRS and HIPEC with a SP approach.

Methods

This study is IDEAL stage I–IIa. Patients with low grade and limited peritoneal malignancy were included in a tertiary care cancer center. Intra- and post-operative adverse events were recorded and classified according to medical and surgical dedicated classifications. The main objective measurement to assess feasibility was the conversion to open or multiport surgery.

Results

A total of 12 highly selected patients were assessed. The median operating time was 240 min (range, 180–360) and two near miss events were reported. Two conversions to open and multiport surgery occurred. The median comprehensive complication index was 0 (range, 0–42.6) with two severe adverse events (Clavien–Dindo or CTC-AE ≥ 3). The median length of stay was 8.5 days (range, 5–13).

Conclusion

CRS and HIPEC via a laparoscopic SP approach are feasible and safe in the short term. The next step should be a prospective development study.

Available only for authorised users

Delhorme JB, Severac F, Averous G et al (2018) Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for pseudomyxoma peritonei of appendicular and extra-appendicular origin. Br J Surg 105:668–676CrossRef

Galan A, Rousset P, Mercier F et al (2018) Overall survival of pseudomyxoma peritonei and peritoneal mesothelioma patients after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy can be predicted by computed tomography quantified sarcopenia. Eur J Surg Oncol 44:1818–1823CrossRef

Kusamura S, Younan R, Baratti D et al (2006) Cytoreductive surgery followed by intraperitoneal hyperthermic perfusion: analysis of morbidity and mortality in 209 peritoneal surface malignancies treated with closed abdomen technique. Cancer 106:1144–1153CrossRef

Najah H, Lo Dico R, Grienay M, Dohan A, Dray X, Pocard M (2016) Single-incision flexible endoscopy (SIFE) for detection and staging of peritoneal carcinomatosis. Surg Endosc 30:3808–3815CrossRef

Passot G, Dumont F, Goéré D et al (2018) Surgery Working Group Multicentre study of laparoscopic or open assessment of the peritoneal cancer index (BIG-RENAPE). Br J Surg. 105:663–667CrossRef

Glehen O, Gilly FN, Boutitie F et al (2010) Toward curative treatment of peritoneal carcinomatosis from nonovarian origin by cytoreductive surgery combined with perioperative intraperitoneal chemotherapy: a multi-institutional study of 1,290 patients. Cancer 116:5608–5618CrossRef

Garofalo A, Valle M, Garcia J, Sugarbaker PH (2006) Laparoscopic intraperitoneal hyperthermic chemotherapy for palliation of debilitating malignant ascites. Eur J Surg Oncol 32:682–685CrossRef

Facchiano E, Risio D, Kianmanesh R, Msika S (2012) Laparoscopic hyperthermic intraperitoneal chemotherapy: indications, aims, and results: a systematic review of the literature. Ann Surg Oncol 19:2946–2950CrossRef

Arjona-Sanchez A, Esquivel J, Glehen O et al (2019) 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 33:854–860CrossRef

10.

Salti GI, Naffouje SA (2019) Feasibility of hand-assisted laparoscopic cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal surface malignancy. Surg Endosc 33:52–57CrossRef

11.

Passot G, Bakrin N, Isaac S et al (2014) Postoperative outcomes of laparoscopic vs open cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy for treatment of peritoneal surface malignancies. Eur J Surg Oncol 40:957–962CrossRef

12.

Sourrouille I, Dumont F, Goéré D, Honoré C, Elias D (2013) Resection of rectal cancer via an abdominal single-port access: short-term results and comparison with standard laparoscopy. Dis Colon Rectum 56:1203–1210PubMed

13.

Dumont F, Duchalais E, Joseph S, Thibaudeau E (2019) Laparoscopic total pelvic exenteration via an extraperitoneal approach. Surg Oncol 28:109CrossRef

14.

Dong B, Luo Z, Lu J et al (2018) Single-incision laparoscopic versus conventional laparoscopic right colectomy: a systematic review and meta-analysis. Int J Surg 55:31–38CrossRef

15.

Jacquet P, Sugarbaker PH (1996) Clinical research methodologies in diagnosis and staging of patients with peritoneal carcinomatosis. Cancer Treat Res 82:359–374CrossRef

16.

McCulloch P, Altman DG, Campbell WB et al (2009) No surgical innovation without evaluation: the IDEAL recommendations. Lancet 374:1105–1112CrossRef

17.

Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383CrossRef

18.

Paul BK, Ihemelandu C, Sugarbaker PH (2018) Prior Surgical Score: an analysis of the prognostic significance of an initial non definitve surgical intervention in patients with peritoneal carcinomatosis of a colorectal origin undergoing cytoreductive surgery and perioperative intraperitoneal chemotherapy. Dis Colon Rectum 61:347–354CrossRef

19.

Francis NK, Curtis NJ, Conti JA et al (2018) EAES classification of intraoperative adverse events in laparoscopic surgery. Surg Endosc 32:3822–3829CrossRef

20.

Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRef

21.

Slankamenac K, Graf R, Barkun J, Puhan MA, Clavien PA (2013) The comprehensive complication index: a novel continuous scale to measure surgical morbidity. Ann Surg 258:1–7CrossRef

22.

Elias D, Honoré C, Ciuchendéa R et al (2008) Peritonel pseudomyxoma: results of a systematic policy of complete cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Br J Surg 95:1164–1171CrossRef

23.

Elias D, Souadka A, Fayard F et al (2012) Variation in the peritoneal cancer index scores between surgeons and according to when they are determined (before or after cytoreductive surgery). Eur J Surg Oncol 38:503–508CrossRef

24.

Han JH, You YK, Choi HJ, Hong TH, Kim DG (2018) Clinical advantages of single port laparoscopic hepatectomy. World J Gastroenterol 24:379–386CrossRef

25.

Piché N, Leblond FA, Sidéris L et al (2011) Rationale for heating oxaliplatin for the intraperitoneal treatment of peritoneal carcinomatosis: a study of the effect of heat on intraperitoneal oxaliplatin using a murine model. Ann Surg 254:138–144CrossRef

26.

Facy O, Al Samman S, Magnin G et al (2012) High pressure enhances the effect of hyperthermia in intraperitoneal chemotherapy with oxaliplatin: an experimental study. Ann Surg 256:1084–1088CrossRef

27.

Kusamura S, Azmi N, Fumagalli L et al (2019) Phase II randomized study on tissue distribution and pharmacokinetics of cisplatin according to different levels of intra-abdominal pressure (IAP) during HIPEC (NCT02949791). Eur J Surg Oncol. https://doi.org/10.1016/j.ejso.2019.06.022 CrossRefPubMed

28.

Nunez MF, Sardi A, Jimenez W et al (2015) Port site metastases is an independent prognostic factor in patients with peritoneal metastasis. Ann Surg Oncol 22:1267–1273CrossRef

29.

Ataseven B, Grimm C, Harter P et al (2016) Prognostic impact of port-site metastasis after diagnostic laparoscopy for epithelial ovarian cancer. Ann Surg Oncol 23:834–840CrossRef

30.

Gesson-Paute A, Ferron G, Thomas F, de Lara EC, Chatelut E, Querleu D (2008) Pharmacokinetics of oxaliplatin during open versus laparoscopically assisted heated intraoperative intraperitoneal chemotherapy (HIPEC): an experimental study. Ann Surg Oncol 15:339–344CrossRef

Title: Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy by laparoscopy via a single-port approach for low-grade peritoneal malignancy
Authors: F. Dumont
E. Duchalais
A. Aumont
E. Thibaudeau
Publication date: 01-06-2020
Publisher: Springer US
Keywords: Laparoscopy
Surgery
Cytostatic Therapy
Published in: Surgical Endoscopy / Issue 6/2020
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-020-07492-w

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy by laparoscopy via a single-port approach for low-grade peritoneal malignancy

Abstract

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 6/2020

Laparoscopic Nissen fundoplication improves disease-specific quality of life in patients with gastroesophageal reflux disease and functional gastroesophageal outflow obstruction

An alternative percutaneous technique for gallbladder drainage using lumen-apposing metal stents

Robotic proctectomy for rectal cancer in the US: a skewed population

Laparoscopic anti-reflux procedures with hepatic shoulder technique in the surgical management of large hiatal hernias and paraesophageal hernias: a follow-up study

Disparity in access to bariatric surgery among African-American men

Formalizing video documentation of the Critical View of Safety in laparoscopic cholecystectomy: a step towards artificial intelligence assistance to improve surgical safety