Section of Surgical Sciences, Division of Surgical Oncology and Endocrine Surgery, 12328Vanderbilt University Medical Center, Nashville, TN, USA.
5708Meharry Medical College, Nashville, TN, USA.
Am Surg. 2022 Apr;88(4):698-703. doi: 10.1177/00031348211048819. Epub 2021 Nov 3.
Outcomes of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) among patients with peritoneal carcinomatosis (PC) depend largely on the extent of peritoneal disease. Since PC is not reliably evaluated with cross-sectional imaging, tumor burden is often evaluated with diagnostic laparoscopy (DLS). The aims of this study are to evaluate the safety of DLS in patients with peritoneal disease and determine if DLS delays time to CRS-HIPEC.
We performed an institutional retrospective review of 145 patients who underwent CRS-HIPEC between 2013 and 2020. Patients were divided into 2 groups: those who underwent an electively scheduled DLS prior to CRS-HIPEC and those who did not. Intraoperative and postoperative complications associated with DLS were determined from the surgeon's operative report. Time from diagnosis of PC to CRS-HIPEC was compared between the 2 groups.
Of the 145 patients available for analysis, 47% (68) underwent DLS and 44% (64) did not. Of all the diagnostic laparoscopies performed, there was 1 (1.5%) intraoperative complication. The duration between diagnosis of peritoneal carcinomatosis and surgery was 4.9 months among patients who underwent DLS prior to CRS-HIPEC and 4.3 months among patients who did not ( = .79).
In this retrospective analysis, diagnostic laparoscopy prior to CRS-HIPEC demonstrated a comparable rate of DLS-associated complications compared to other gastrointestinal malignancies and does not prolong time from diagnosis to CRS-HIPEC. Thus, in patients undergoing evaluation for CRS-HIPEC, diagnostic laparoscopy provides significant value in patient selection without incurring perioperative risk or delay in CRS-HIPEC.
腹膜恶性肿瘤患者接受细胞减灭术联合腹腔热灌注化疗（CRS-HIPEC）的治疗效果在很大程度上取决于腹膜疾病的严重程度。由于腹膜恶性肿瘤不能通过横断面成像进行可靠评估，因此肿瘤负担通常通过诊断性腹腔镜检查（DLS）进行评估。本研究旨在评估 DLS 在患有腹膜疾病患者中的安全性，并确定 DLS 是否会延迟 CRS-HIPEC 的时间。
我们对 2013 年至 2020 年间接受 CRS-HIPEC 治疗的 145 例患者进行了机构回顾性分析。患者分为两组：一组在 CRS-HIPEC 前接受择期 DLS，另一组则未接受。从外科医生的手术报告中确定与 DLS 相关的术中及术后并发症。比较两组患者从诊断为腹膜恶性肿瘤到 CRS-HIPEC 的时间。
在可进行分析的 145 例患者中，68 例（47%）接受了 DLS，64 例（44%）未接受。所有进行的诊断性腹腔镜检查中，有 1 例（1.5%）出现术中并发症。在接受 DLS 的患者中，从诊断为腹膜恶性肿瘤到手术的时间为 4.9 个月，而未接受 DLS 的患者为 4.3 个月（ =.79）。
在这项回顾性分析中，与其他胃肠道恶性肿瘤相比，CRS-HIPEC 前的诊断性腹腔镜检查与 DLS 相关并发症的发生率相当，并且不会延长从诊断到 CRS-HIPEC 的时间。因此，在接受 CRS-HIPEC 评估的患者中，诊断性腹腔镜检查在不增加围手术期风险或延迟 CRS-HIPEC 的情况下，为患者选择提供了重要价值。
