Skip to main content
SpringerLink
Log in

An 18-Year Experience in Diagnostic Laparoscopy of Peritoneal Carcinomatosis: Results from 744 Patients

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Despite accurate preoperative imaging assessment, optimal cytoreductive surgery with hyperthermic intraperitoneal chemotherapy remains unfeasible in many patients with peritoneal carcinomatosis at the time of surgery. The aim of this study was to evaluate the role of diagnostic laparoscopy in the selection of candidates.

Methods

Prospectively collected data of all patients undergoing diagnostic laparoscopy in our Department were retrospectively analyzed. Demographics and perioperative features as well as operative details and outcome were evaluated.

Results

The study included 744 consecutive patients. Primary ovarian tumors were the most common indications, followed by gastric tumors and recurrent colorectal cancers. The procedure was successfully completed in 99.73% of cases. Approximately two thirds of them (68%) had undergone previous surgical procedures. The presence of ascites was recorded in 482 patients (64.78%). A total of 374 (50.3%) patients were excluded from surgical exploration. Among those who eventually underwent surgery, CC0 resection was obtained in 64.6% (239) of cases. Understaging of peritoneal carcinomatosis was observed in 11 patients (1.48%). Postoperative mortality was null and 5 (0.8%) complications were observed. Three (0.4%) port-site metastases were recorded at the beginning of the experience.

Conclusion

Diagnostic laparosocopy is a safe and feasible tool able to improve the selection of patients eligible for cytoreduction with hyperthermic intraperitoneal chemotherapy, at the same time allowing avoiding a significant number of unnecessary laparotomies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Dohan A, Hobeika C, Najah H, Pocard M, Rousset P, Eveno C. Preoperative assessment of peritoneal carcinomatosis of colorectal origin. J Visc Surg. 2018;155:293–303.

    Article  CAS  Google Scholar 

  2. Guerrero W, Munene G, Dickson PV, Stiles ZE, Mays J, Davidoff AM, Glazer ES, Shibata D, Deneve JL. Outcome and factors associated with aborted cytoreduction for peritoneal carcinomatosis. J Gastrointest Oncol. 2018;9:664–673.

    Article  Google Scholar 

  3. Valle M, Federici O, Garofalo A. Patient selection for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, and role of laparoscopy in diagnosis, staging, and treatment. Surg Oncol Clin N Am. 2012;21:515–31.

    Article  Google Scholar 

  4. Rutten MJ, van Meurs HS, van de Vrie R, Gaarenstroom KN, Naaktgeboren CA, van Gorp T, Ter Brugge GT, Hofhuis W, Schreuder HWR, Arts HJG, Zusterzeel PLM, Pijnenborg JMA, van Haaften M, Fons G, Engelen MJA, Boss EA, Vos MC, Gerestein KG, Schutter EMJ, Opmeer BC, Spijkerboer AM, Bossuyt PMM, Mol BW, Kenter GG, Buist MR. Laparoscopy to Predict the Result of Primary Cytoreductive Surgery in Patients With Advanced Ovarian Cancer: A Randomized Controlled Trial. J Clin Oncol. 2017;35:613–621.

    Article  Google Scholar 

  5. Gómez-Hidalgo NR, Martinez-Cannon BA, Nick AM, Lu KH, Sood AK, Coleman RL, Ramirez PT. Predictors of optimal cytoreduction in patients with newly diagnosed advanced-stage epithelial ovarian cancer: Time to incorporate laparoscopic assessment into the standard of care. Gynecol Oncol. 2015;137:553–558.

    Article  Google Scholar 

  6. Hansen JM, Sood AK, Coleman RL, Westin SN, Soliman PT, Ramirez PT, Fellman BM, Schmeler KM, Fleming ND. Concordance of laparoscopic scoring algorithm with primary surgery findings in advanced stage ovarian cancer. Gynecol Oncol 2018;151:428–432.

    Article  Google Scholar 

  7. Valle M, Van der Speeten K, Garofalo A. Laparoscopic hyperthermic intraperitoneal peroperative chemotherapy (HIPEC) in the management of refractory malignant ascites: A multi-institutional retrospective analysis in 52 patients. J Surg Oncol. 2009;100:331–334.

    Article  CAS  Google Scholar 

  8. von Breitenbuch P, Boerner T, Jeiter T, Piso P, Schlitt HJ. Laparoscopy as a useful selection tool for patients with prior surgery and peritoneal metastases suitable for multimodality treatment strategies. Surg Endosc. 2018;32:2288–2294.

    Article  Google Scholar 

  9. van Oudheusden TR, Braam HJ, Luyer MD, Wiezer MJ, van Ramshorst B, Nienhuijs SW, de Hingh IH. Peritoneal cancer patients not suitable for cytoreductive surgery and HIPEC during explorative surgery: risk factors, treatment options, and prognosis. Ann Surg Oncol. 2015;22:1236–1242.

    Article  Google Scholar 

  10. Nasser S, Lazaridis A, Evangelou M, Jones B, Nixon K, Kyrgiou M, Gabra H. Correlation of pre-operative CT findings with surgical & histological tumor dissemination patterns at cytoreduction for primary advanced and relapsed epithelial ovarian cancer: A retrospective evaluation. Gynecol Oncol. 2016;143:264–269.

    Article  CAS  Google Scholar 

  11. Pounds R, Phillips A, Kehoe S, Nevin J, Sundar S, Elattar A, Teo HG, Singh K, Balega J. Diaphragm disease in advanced ovarian cancer: Predictability of pre-operative imaging and safety of surgical intervention. Eur J Obstet Gynecol Reprod Biol. 2018;226:47–53.

    Article  Google Scholar 

  12. Menassel B, Duclos A, Passot G, Dohan A, Payet C, Isaac S, Valette PJ, Glehen O, Rousset P. Preoperative CT and MRI prediction of non-resectability in patients treated for pseudomyxoma peritonei from mucinous appendiceal neoplasms. Eur J Surg Oncol. 2016;42:558–566.

    Article  CAS  Google Scholar 

  13. Low RN, Barone RM. Imaging for Peritoneal Metastases. Surg Oncol Clin N Am. 2018 Jul;27(3):425–442.

    Article  Google Scholar 

  14. van 't Sant I, van Eden WJ, Engbersen MP, Kok NFM, Woensdregt K, Lambregts DMJ, Shanmuganathan S, Beets-Tan RGH, Aalbers AGJ, Lahaye MJ. Diffusion-weighted MRI assessment of the peritoneal cancer index before cytoreductive surgery. Br J Surg. 2019;106:491–498.

  15. Michielsen KL, Vergote I, Dresen R, Op de Beeck K, Vanslembrouck R, Amant F, Leunen K, Moerman P, Fieuws S, De Keyzer F, Vandecaveye V. Whole-body diffusion-weighted magnetic resonance imaging in the diagnosis of recurrent ovarian cancer: a clinical feasibility study. Br J Radiol. 2016;89:20160468. Epub 2016 Sep 21.

    Article  Google Scholar 

  16. Torkzad MR, Casta N, Bergman A, Ahlström H, Påhlman L, Mahteme H. Comparison between MRI and CT in prediction of peritoneal carcinomatosis index (PCI) in patients undergoing cytoreductive surgery in relation to the experience of the radiologist. J Surg Oncol. 2015 May;111(6):746–51. doi: https://doi.org/10.1002/jso.23878. Epub 2015 Jan 8.

  17. Li J, Yan R, Lei J, Jiang C. Comparison of PET with PET/CT in detecting peritoneal carcinomatosis: a meta-analysis. Abdom Imaging. 2015 Oct;40(7):2660–2666.

    Article  Google Scholar 

  18. Wang W, Tan GHC, Chia CS, Skanthakumar T, Soo KC, Teo MCC. Are positron emission tomography-computed tomography (PET-CT) scans useful in preoperative assessment of patients with peritoneal disease before cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC)? Int J Hyperthermia. 2018 34(5):524–531.

    Article  Google Scholar 

  19. Pasqual EM, Bertozzi S, Bacchetti S, Londero AP, Basso SM, Santeufemia DA, Lo Re G, Lumachi F. Preoperative assessment of peritoneal carcinomatosis in patients undergoing hyperthermic intraperitoneal chemotherapy following cytoreductive surgery. Anticancer Res. 2014;34:2363–2368.

    PubMed  Google Scholar 

  20. Audollent R, Eveno C, Dohan A, Sarda L, Jouvin I, Soyer P, Pocard M. Pitfalls and mimickers on (18)F-FDG-PET/CT in peritoneal carcinomatosis from colorectal cancer: An analysis from 37 patients. J Visc Surg. 2015;152:285–291.

    Article  CAS  Google Scholar 

  21. Lopez-Lopez V, Cascales-Campos PA, Gil J, Frutos L, Andrade RJ, Fuster-Quiñonero M, Feliciangeli E, Gil E, Parilla P. Use of (18)F-FDG PET/CT in the preoperative evaluation of patients diagnosed with peritoneal carcinomatosis of ovarian origin, candidates to cytoreduction and hipec. A pending issue. Eur J Radiol. 2016;85:1824–1828.

    Article  CAS  Google Scholar 

  22. Suidan RS, Ramirez PT, Sarasohn DM, Teitcher JB, Iyer RB, Zhou Q, Iasonos A, Denesopolis J, Zivanovic O, Roche KCL, Sonoda Y, Coleman RL, Abu-Rustum NR, Hricak H, Chi DS. A multicenter assessment of the ability of preoperative computed tomography scan and CA-125 to predict gross residual disease at primary debulking for advanced epithelial ovarian cancer. Gynecol Oncol. 2017;145:27–31.

    Article  Google Scholar 

  23. Dessapt AL, Huchon C, Ngo C, Bats AS, Bensaid C, Lecuru F. Is complete cytoreductive surgery feasible in this patient with ovarian cancer? Surg Oncol. 2016;25:326–331.

    Article  Google Scholar 

  24. Tan GHC, Kwek JW, Hosseini R, Chanyaputhipong J, Tham CK, Soo KC, Teo MCC. Proposed radiological criteria for pre-operative determination of respectability in peritoneal-based malignancies. J Med Imaging Radiat Oncol. 2016;60:337–343.

    Article  Google Scholar 

  25. Kasper SM, Dueholm M, Marinovskij E, Blaakær J. Imaging diagnostics in ovarian cancer: magnetic resonance imaging and a scoring system guiding choice of primary treatment. Eur J Obstet Gynecol Reprod Biol. 2017;210:83–89.

    Article  Google Scholar 

  26. Chesnais M, Lecuru F, Mimouni M, Ngo C, Fauconnier A, Huchon C. A pre-operative predictive score to evaluate the feasibility of complete cytoreductive surgery in patients with epithelial ovarian cancer. PLoS One. 2017;12:e0187245.

    Article  Google Scholar 

  27. Flicek K, Ashfaq A, Johnson CD, Menias C, Bagaria S, Wasif N. Correlation of Radiologic with Surgical Peritoneal Cancer Index Scores in Patients with Pseudomyxoma Peritonei and Peritoneal Carcinomatosis: How Well Can We Predict Resectability? J Gastrointest Surg. 2016;20:307–312.

    Article  Google Scholar 

  28. Nick AM, Coleman RL, Ramirez PT, Sood AK. A framework for a personalized surgical approach to ovarian cancer. Nat Rev Clin Oncol. 2015;12:239–245.

    Article  CAS  Google Scholar 

  29. Mohkam K, Passot G, Cotte E, Bakrin N, Gilly FN, Ledochowski S, Bernard L, Valette PJ, Glehen O, Rousset P. Resectability of Peritoneal Carcinomatosis: Learnings from a Prospective Cohort of 533 Consecutive Patients Selected for Cytoreductive Surgery. Ann Surg Oncol. 2016;23:1261–1270.

    Article  Google Scholar 

  30. Bravo R, Jafari MD, Pigazzi A. The Utility of Diagnostic Laparoscopy in Patients Being Evaluated for Cytoreductive Surgery and Hyperthermic Peritoneal Chemotherapy. Am J Clin Oncol. 2018;41:1231–1234.

    Article  Google Scholar 

  31. Marmor RA, Kelly KJ, Lowy AM, Baumgartner JM. Laparoscopy is Safe and Accurate to Evaluate Peritoneal Surface Metastasis Prior to Cytoreductive Surgery. Ann Surg Oncol. 2016;23:1461–1467.

    Article  Google Scholar 

  32. Tabrizian P, Jayakrishnan TT, Zacharias A, Aycart S, Johnston FM, Sarpel U, Labow D, Turaga KK. Incorporation of diagnostic laparoscopy in the management algorithm for patients with peritoneal metastases: A multi-institutional analysis. J Surg Oncol. 2015;111:1035–1040.

    Article  Google Scholar 

  33. Jayakrishnan TT, Zacharias AJ, Sharma A, Pappas SG, Gamblin TC, Turaga KK. Role of laparoscopy in patients with peritoneal metastases considered for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC). World J Surg Oncol. 2014;12:270.

    Article  Google Scholar 

  34. Iversen LH, Rasmussen PC, Laurberg S. Value of laparoscopy before cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis. Br J Surg. 2013;100:285–292.

    Article  CAS  Google Scholar 

  35. Fleming ND, Nick AM, Coleman RL, Westin SN, Ramirez PT, Soliman PT, Fellman B, Meyer LA, Schmeler KM, Lu KH, Sood AK. Laparoscopic Surgical Algorithm to Triage the Timing of Tumor Reductive Surgery in Advanced Ovarian Cancer. Obstet Gynecol. 2018;132:545–554.

    Article  Google Scholar 

  36. Feng Z, Wen H, Jiang Z, Liu S, Ju X, Chen X, Xia L, Xu J, Bi R, Wu X. A triage strategy in advanced ovarian cancer management based on multiple predictive models for R0 resection: a prospective cohort study. J Gynecol Oncol. 2018;29(5):e65.

    Article  Google Scholar 

  37. Eoh KJ, Yoon JW, Lee JY, Nam EJ, Kim S, Kim SW, Kim YT. A novel algorithm for the treatment strategy for advanced epithelial ovarian cancer: consecutive imaging, frailty assessment, and diagnostic laparoscopy. BMC Cancer. 2017;17:481.

    Article  Google Scholar 

  38. van de Vrie R, van Meurs HS, Rutten MJ, Naaktgeboren CA, Opmeer BC, Gaarenstroom KN, van Gorp T, ter Brugge HG, Hofhuis W, Schreuder HWR, Arts HJG, Zusterzeel PLM, Pijnenborg JMA, van Haaften M, Engelen MJA, Boss EA, Vos MC, Gerestein KG, Schutter EMJ, Kenter GG, Bossuyt PMM, Mol BW, Buist MR. Cost-effectiveness of laparoscopy as diagnostic tool before primary cytoreductive surgery in ovarian cancer. Gynecol Oncol. 2017;146:449–456.

    Article  Google Scholar 

  39. Valle SJ, Alzahrani NA, Alzahrani SE, Liauw W, Morris DL. Laparoscopic hyperthermic intraperitoneal chemotherapy (HIPEC) for refractory malignant ascites in patients unsuitable for cytoreductive surgery. Int J Surg. 2015;23:176–180.

    Article  CAS  Google Scholar 

  40. Randle RW, Swett KR, Swords DS, Shen P, Stewart JH, Levine EA, Votanopoulos KI. Efficacy of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy in the management of malignant ascites. Ann Surg Oncol. 2014;21:1474–1479.

    Article  Google Scholar 

  41. Ba M, Long H, Zhang X, Tang Y, Wu Y, Wang S, Yan Z, Zhang B, Cui S. Hyperthermic Intraperitoneal Perfusion Chemotherapy and Cytoreductive Surgery for Controlling Malignant Ascites From Ovarian Cancer. Int J Gynecol Cancer. 2016;26:1571–1579.

    Article  Google Scholar 

  42. Liu L, Zhang N, Min J, Su H, Wang H, Chen D, Sun L, Zhang H, Li W, Zhang H. Retrospective analysis on the safety of 5,759 times of bedside hyperthermic intra-peritoneal or intra-pleural chemotherapy (HIPEC). Oncotarget. 2016;7:21570–21578.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Digestive Surgery, IRCCS Regina Elena National Cancer Institute, via Elio Chianesi 53, 00144, Rome, Italy

    Fabio Carboni, Orietta Federici, Manuel Giofrè & Mario Valle

Authors
  1. Fabio Carboni
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Orietta Federici
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Manuel Giofrè
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mario Valle
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

FC, OF, MG and MV participated in the:

- Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work;

- Drafting the work or revising it critically for important intellectual content;

- Final approval of the version to be published;

- Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Fabio Carboni.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Carboni, F., Federici, O., Giofrè, M. et al. An 18-Year Experience in Diagnostic Laparoscopy of Peritoneal Carcinomatosis: Results from 744 Patients. J Gastrointest Surg 24, 2096–2103 (2020). https://doi.org/10.1007/s11605-019-04368-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-019-04368-w

Keywords

Search

Navigation