Aulicino Matteo, Abatini Carlo, Ferracci Federica, D'Annibale Giorgio, Lodoli Claudio, Di Giorgio Andrea, El Halabieh Miriam Attalla, Palmieri Luca, Oliva Riccardo, Gallotta Valerio, Pacelli Fabio, Santullo Francesco
Catholic University of the Sacred Heart, Rome, Italy.
Surgical Unit of Peritoneum and Retroperitoneum Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Ann Surg Oncol. 2025 Jul 16. doi: 10.1245/s10434-025-17591-4.
Abdominal multicystic peritoneal mesothelioma (MCPM) is a rare condition characterized by multiple serous cysts, predominantly affecting the pelvic peritoneum. There is no consensus on the clinical management of MCPM, although surgical resection remains the first-line treatment. Given its low malignant potential, the goal is complete cyst removal to alleviate symptoms and improve quality of life. In selected cases, laparoscopic surgery offers a less invasive alternative to open surgery, with several advantages, including reduced postoperative morbidity and faster recovery. However, owing to the anatomical complexity, the procedure should be performed at specialized centers to ensure optimal outcomes. PATIENTS AND METHODS: This report presents two cases of MCPM in female patients who underwent laparoscopic cytoreductive surgery (CRS). Considering the technical challenges of laparoscopic dissection in the pelvis, this series focuses on a laparoscopic peritonectomy technique guided by the dissection of the pelvic spaces. A video provides the detailed, step-by-step surgical techniques and postoperative course.
The two cases illustrate tailored surgical strategies. In the first case, a uterus-sparing approach was employed to preserve the possibility of future heterologous fertility. In the second, a hysterectomy was performed owing to uterine infiltration by cystic disease, with specimen extraction via the transvaginal route, enabling scarless cytoreduction. Despite longer operative times, laparoscopy facilitated faster recovery and shorter hospital stays.
Laparoscopic cytoreduction is feasible in selected patients with minimal disease burden. Owing to the surgical complexity, minimally invasive cytoreduction should only be performed after achieving technical proficiency in open cytoreductive surgery. Furthermore, a structured mentoring program and multidisciplinary support are essential for its safe implementation.
腹部多囊性腹膜间皮瘤（MCPM）是一种罕见疾病，其特征为多个浆液性囊肿，主要累及盆腔腹膜。尽管手术切除仍是一线治疗方法，但对于MCPM的临床管理尚无共识。鉴于其恶性潜能较低，目标是完整切除囊肿以缓解症状并提高生活质量。在某些病例中，腹腔镜手术提供了一种比开放手术侵入性更小的替代方法，具有多种优势，包括降低术后发病率和更快恢复。然而，由于解剖结构复杂，该手术应在专业中心进行以确保最佳效果。
本报告介绍了两例接受腹腔镜细胞减灭术（CRS）的女性MCPM患者。考虑到盆腔腹腔镜解剖的技术挑战，本系列重点关注一种以盆腔间隙解剖为指导的腹腔镜腹膜切除术技术。一段视频展示了详细的、逐步的手术技术和术后过程。
这两个病例展示了量身定制的手术策略。在第一个病例中，采用了保留子宫的方法以保留未来异体生育的可能性。在第二个病例中，由于囊性疾病浸润子宫而进行了子宫切除术，经阴道途径取出标本，实现了无瘢痕细胞减灭。尽管手术时间较长，但腹腔镜手术促进了更快的恢复和更短的住院时间。
腹腔镜细胞减灭术在疾病负担最小的特定患者中是可行的。由于手术复杂性，微创细胞减灭术应仅在开放细胞减灭术技术熟练后进行。此外，结构化的指导计划和多学科支持对于其安全实施至关重要。
