Technical aspects of cytoreductive surgery

Abstract

At the Fifth International Workshop on Peritoneal Surface Malignancy, in Milan, the consensus on technical aspects of cytoreductive surgery (CRS) for peritoneal surface malignancy was obtained through the Delphi process. Five conflicting points were discussed: radicality of the peritonectomy procedure, cytoreduction of neoplastic nodules <2.5 mm, the timing of bowel anastomoses in relation to hyperthermic intraperitoneal chemotherapy (HIPEC) and indications of protective ostomies. According to the panel of experts a partial parietal peritonectomy restricted to the macroscopically involved regions could be indicated in all listed clinical conditions with the exception of peritoneal mesothelioma. No expert was of the opinion that a radical parietal peritonectomy is advisable irrespective of the disease being treated. All the experts agreed that electrovaporization of small (<2.5 mm) non-infiltrating metastatic nodules in the mesentery would be appropriate, even if theoretically the HIPEC affords microscopic cytoreduction. The panel also agreed that in the closed technique for HIPEC administration the intestinal anastomoses should be fashioned after completion of the perfusion. Finally when considering the place for protective ostomies the experts voted for a flexible approach allowing the surgeon to exercise discretion for individual patients.

Predictors of morbidity and mortality in patients submitted to cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy for ovarian carcinomatosis: a multicenter study

“…The analysis of the results of our experience, compared to those of the largest published experiences ( Table 6 ), shows morbidity and mortality within the range. The predictors of morbidity emerging from our case histories, number of intraoperative transfusions and PCI, are also shared by other authors [ 34 , 40 ].…”

Cytoreductive procedures—strategies to reduce postoperative morbidity and management of surgical complications with special emphasis on anastomotic leaks

“…Verwaal et al [19] performed a protective colostomy in 42% of their patients, but complications occurred in almost 18% of the patients despite the stoma. In accordance with a recent consensus, we do not perform routinely a diverting stoma in case of rectal resection, but it should be noted that there is substantial variation among cytoreduction experts [24]. A synopsis of the different treatment options in case of anastomotic leakages after cytoreductive surgery is given in Table III.…”

Peritonectomy Techniques

“…PRT procedures were described by Sugarbaker in 1995 and then integrated with other publications [1,2,12,13]. However, few technical contributions are described in the literature, even if the importance of maximal cytoreduction is recognized in all PSM as the most significant prognostic factor [14][15][16][17][18][19][20].…”