Robotic Cytoreductive Surgery With Heated Intraperitoneal Chemotherapy

Area of Science:

• Surgical Oncology
• Minimally Invasive Surgery
• Gastrointestinal Oncology

Background:

• Cytoreductive surgery with heated intraperitoneal chemotherapy (CRS-HIPEC) is a standard treatment for peritoneal carcinomatosis but is traditionally performed via open surgery.
• Minimally invasive approaches to CRS-HIPEC are emerging, yet achieving complete cytoreduction (CCR) using these techniques is less frequently reported.

Observation:

• A 49-year-old male with metastatic low-grade mucinous appendiceal neoplasm (LAMN) to the peritoneum was treated with robotic CRS-HIPEC.
• Diagnostic laparoscopy revealed a low Peritoneal Cancer Index (PCI) score of 5, indicating limited peritoneal disease.
• Robotic cytoreduction was successfully performed, achieving a completeness of cytoreduction (CCR) score of 0, followed by HIPEC with mitomycin C.

Findings:

• Robotic-assisted CRS-HIPEC is feasible for select cases of LAMN with peritoneal metastasis.
• Complete cytoreduction (CCR 0) was achieved robotically in this patient with LAMN.
• The procedure involved robotic cytoreduction followed by HIPEC using mitomycin C.

Implications:

• This case supports the use of robotic-assisted CRS-HIPEC as a viable minimally invasive option for carefully selected LAMN patients.
• Advocates for the continued exploration and application of minimally invasive techniques in managing peritoneal surface malignancies.
• Highlights the potential for robotic surgery to improve outcomes and reduce invasiveness in CRS-HIPEC procedures.