Alshammari Turki, Alshammari Sulaiman, Hakami Riyadh, Alharbi Abdullah, Alyami Mohammad, Abdulla Maha, Bin Traiki Thamer
Department of Surgery, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.
Department of Anesthesia, College of Medicine, King Khalid University Hospital, King Khalid University Hospital, Riyadh, Saudi Arabia.
Am J Case Rep. 2019 Nov 9;20:1648-1651. doi: 10.12659/AJCR.918064.
BACKGROUND Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy is one of the treatment options in low-grade appendiceal mucinous neoplasm with peritoneal dissemination. The minimal invasive surgery approach was introduced to the field after years of traditional open technique. Multi-port laparoscopic and robotic techniques were reported with good short-term outcomes in very selected patients with low PCI scores. We describe here the first single-port laparoscopic approach of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. CASE REPORT We present a case of low-grade appendiceal mucinous neoplasm with peritoneal dissemination, in which single-port laparoscopic approach of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy was completed through a 5.5-cm incision. A 35-year-old man with no medical illness underwent laparoscopic appendectomy for acute appendicitis 3 months earlier. Postoperative surgical pathology reported a low-grade appendiceal mucinous neoplasm with positive margin. After complete assessment and Tumor Board discussion, the patient was scheduled for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. A single gel port access was inserted through a 5.5-cm peri-umbilical incision. The Peritoneal Cancer Index score was 4, and the decision was made to proceed with partial cecectomy, omentectomy, peritonectomy, and hyperthermic intraperitoneal chemotherapy with the Sugarbaker mitomycin C-based regimen. Postoperative care was carried out following the Enhanced Recovery After Surgery protocol. The patient was discharged on day 3 without any complications. CONCLUSIONS A single-port laparoscopic approach in cytoreductive surgery with hyperthermic intraperitoneal chemotherapy is safe and feasible in very selected patients, and has the advantage of direct visualization and palpation through the incision to determine more accurate Peritoneal Cancer Index assessment in comparison to other MIS approaches. Nevertheless, additional prospective studies are needed.
细胞减灭术联合腹腔热灌注化疗是伴有腹膜播散的低级别阑尾黏液性肿瘤的治疗选择之一。在多年传统开放技术之后，微创外科手术方法被引入该领域。多端口腹腔镜和机器人技术在非常选定的低腹膜癌指数（PCI）评分患者中报告了良好的短期结果。我们在此描述首例单端口腹腔镜细胞减灭术联合腹腔热灌注化疗。
我们呈现一例伴有腹膜播散的低级别阑尾黏液性肿瘤病例，其中通过一个5.5厘米的切口完成了单端口腹腔镜细胞减灭术联合腹腔热灌注化疗。一名35岁无基础疾病的男性3个月前因急性阑尾炎接受了腹腔镜阑尾切除术。术后手术病理报告为低级别阑尾黏液性肿瘤，切缘阳性。经过全面评估和多学科会诊讨论后，该患者被安排进行细胞减灭术联合腹腔热灌注化疗。通过一个5.5厘米的脐周切口插入单个凝胶端口通路。腹膜癌指数评分为4，决定采用基于丝裂霉素C的Sugarbaker方案进行部分盲肠切除术、大网膜切除术、腹膜切除术和腹腔热灌注化疗。术后按照加速康复外科方案进行护理。患者在第3天出院，无任何并发症。
单端口腹腔镜细胞减灭术联合腹腔热灌注化疗在非常选定的患者中是安全可行的，与其他微创方法相比，具有通过切口直接可视化和触诊以更准确评估腹膜癌指数的优势。尽管如此，仍需要更多的前瞻性研究。
