Complete laparoscopic pelvic peritonectomy plus hyperthermic intraperitoneal chemotherapy.

Area of Science:

• Surgical Oncology
• Minimally Invasive Surgery
• Gastrointestinal Oncology

Background:

• Peritoneal carcinomatosis presents a significant challenge in managing advanced cancers.
• Complete cytoreduction is crucial for improving outcomes in patients with peritoneal carcinomatosis.
• Traditional open surgical approaches can be highly invasive.

Purpose of the Study:

• To present the surgical technique for complete laparoscopic pelvic peritonectomy (LPP) plus hyperthermic intraperitoneal chemotherapy (HIPEC).
• To report the early clinical outcomes of this minimally invasive approach.
• To establish LPP + HIPEC as a feasible and safe alternative for selected patients.

Main Methods:

• A prospective study involving consecutive patients with limited peritoneal carcinomatosis (peritoneal carcinomatosis index < 10) from ovarian, colon cancer, and mesothelioma.
• The study was conducted between January 2017 and November 2019 at two Spanish referral centers.
• Perioperative, pathological, and 30-day morbidity and mortality data were analyzed. Surgical technique was documented via video.

Main Results:

• Twelve patients underwent LPP + HIPEC, achieving 100% complete cytoreduction.
• The median operative time was 450 minutes, with 16% experiencing Grade IIIa morbidity and no mortality.
• Median hospital stay was 5.5 days, with a median follow-up of 10 months. One patient had a splenic hilum recurrence, and another had a nodal recurrence.

Conclusions:

• This study demonstrates the first technical video of a minimally invasive approach for complete pelvic peritonectomy with omentectomy and HIPEC.
• The LPP + HIPEC procedure is a feasible and safe alternative to open surgery for highly selected patients.
• The technique offers a less invasive option for managing limited peritoneal carcinomatosis, with promising early results.