Jennifer K Keller, Laurence P Diggs, Jiashou J Xu, Jula Veerapong. St Louis University
Introduction: Laparoscopic cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) has been utilized for patients with a low peritoneal
carcinomatosis index (PCI) score. Several studies have examined the feasibility of this approach and reported similar short-term outcomes with shorter length of stay, reduced morbidity, and fewer post-operative complications. When performing CRS, it is essential to understand the various anatomic challenges to performing a complete cytoreduction. Areas such as the posterior aspect of the spleen, the right lobe of the liver and Morison’s Pouch, lesser sac, caudate recess, pont hepatique, the lesser sac, paraduodenal recess, and the pelvis can all harbor occult malignancy. We herein describe a technique of laparoscopic cytoreduction which allows full abdominal cavity exploration without compromise to oncologic integrity.
Methods: Three patients, including two with low grade appendiceal mucinous neoplasm and one with invasive appendiceal adenocarcinoma, were included in this series. The patients underwent staging computed tomography imaging and colonoscopy. All patients underwent diagnostic laparoscopy and PCI scores were calculated. The PCI divides the abdomen and pelvis into 9 regions with each region given a score between 0-3 based on the largest lesion size in that region for a maximal score of 39. Patients with PCI scores<10 underwent laparoscopic CRS/HIPEC.
Results: The 3 patients underwent complete laparoscopic examination of all peritoneal surfaces including anatomically challenging areas. Peritoneal surfaces were examined and complete cytoreduction was insured. The specimen extraction site and port sites were then utilized to place the inflow and outflow cannulas. All patients received 90 minutes of HIPEC with 40 mg of Mitomycin-C.
Conclusion: Laparoscopic CRS/HIPEC should be considered for limited peritoneal disease.
Complete laparoscopic examination of peritoneal surfaces is feasible and HIPEC can be performed through port sites.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80760
Program Number: V086
Presentation Session: Friday Exhibit Hall Video Presentations Session 2 (Non CME)
Presentation Type: EHVideo