Selection Criteria for Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy With Special Emphasis on Laparoscopy as an Efficient Tool

Abstract

Background/aim: The aim of the study was to assess diagnostic tools implemented in selecting candidates for cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) with special emphasis on diagnostic laparoscopy.

Patients and methods: A total of 229 patients underwent laparoscopy between January 2011 and December 2015 with peritoneal carcinomatosis and were analyzed retrospectively to study the role of laparoscopy in selecting patients for CRS and HIPEC.

Results: After initial laparoscopy, 101 (44%) of patients underwent CRS and HIPEC with 128 (56%) being aborted. The most prevalent overall exclusion criterion was extensive small bowel disease with a prevalence of 107 (47%) patients. The rate of complete cytoreduction (CCR0 and CCR1) in patients who were deemed initially operable during laparoscopy was 96%. The most prevalent primary tumor site was the stomach with a prevalence of 36,7%. The overall median peritoneal cancer index (PCI) score of the excluded patients were 16.8 and 4.6 in the CRS and HIPEC group. Port-site metastasis was 3.1% and bowel perforation rate 3.0%.

Conclusion: Laparoscopy is a proper selection tool in patients with peritoneal metastases for multimodal treatment. Sensitivity for detecting non-resectable patients is high and the morbidity and mortality low.

Keywords: CRS and HIPEC staging; Peritoneal carcinomatosis; operability.