Incorporation of diagnostic laparoscopy in the management algorithm for patients with peritoneal metastases: A multi‐institutional analysis

Abstract

Diagnostic laparoscopy can be safely incorporated in the management of patients with peritoneal metastases, and can be especially beneficial in excluding patients from attempted incomplete cytoreduction.

Role of diagnostic laparoscopy in patients with suspicion of colorectal peritoneal metastases to evaluate suitability for cytoreductive surgery with hyperthermic intraperitoneal chemotherapy

“…Comparison of the main results of the present study with those from the seven previously published retrospective studies on the value of DLS in the preoperative workup for CRS + HIPEC is challenging. There are striking differences in patient populations, tumour types, definitions of a good laparoscopic evaluation of the abdominal cavity, and the indications for performing DLS or CRS + HIPEC.…”

“…Only von Breitenbuch and colleagues used a definition similar to that used in the present study, resulting in a good laparoscopic evaluation in 88 per cent of patients with no history of previous abdominal surgery and in 70 per cent of those with such a history. Postoperative complication rates from the seven retrospective studies ranged between 0 and 2 per cent . These studies included only patients without palliative surgery during DLS, and for this specific group the results of the present study are comparable.…”

“…Some argue that adhesions from the cancer or previous abdominal surgery impede optimal visualization during DLS, which could result in underestimation of the PCI and an increased rate of intraoperative and postoperative complications. In contrast, seven retrospective studies concluded that DLS is a safe, feasible and accurate staging tool for assessing tumour burden in patients with PM. Therefore, several institutions worldwide perform DLS routinely in patients with PM to investigate their presence and resectability.…”

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients with liver involvement

“…Compared to CRC‐PC patients without liver involvement, the overall survival of those with liver involvement was significantly unfavorable; this survival difference is likely attributable to the more disseminated peritoneal disease observed in group 1 as well as the higher proportion of incomplete cytoreduction, since these two factors have been recognized as the most important prognostic predictors following CRS/HIPEC. As we gained experience with CRS/HIPEC procedures, we have adopted several inclusion criteria for CRS/HIPEC in patients with PC and liver involvement: patients with CRC were typically required to undergo neoadjuvant systemic chemotherapy with demonstration of a progression‐free interval of at least 3 months; patients were required to be surgical candidates with good performance status; as described in the literature, only patients with PCI scores <21 were considered likely to be optimally cytoreduced and staged diagnostic laparoscopy was liberally used to assess whether this would be feasible . Surgery was infrequently employed in patients with high‐volume peritoneal disease (PCI ≥ 21), particularly in the setting of concurrent large hepatic tumor burden, and most of these patients were operated on during the early study period, which reflects our learning curve in terms of patient selection.…”

Diagnostic role of staging laparoscopy in a subset of biliary cancers: a meta‐analysis

“…Laparoscopy provides a direct vision of peritoneal metastases. The accuracy of laparoscopic peritoneal metastases is >90% . However, biopsy of the primary lesion is not recommended because of the chance of seeding the primary lesions of bile duct tumours …”