Short-term outcomes of laparoscopic versus open cytoreductive surgery: a propensity score matching analysis

Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is a complex and lengthy surgical procedure involving multi-visceral resection, characterized by a steep and non-standardized learning curve. Therefore, laparoscopic surgery has faced significant challenges in being adopted for cytoreduction of peritoneal metastases. However, advancements in laparoscopic techniques have gradually allowed the adoption, in a limited and selected patient population, of laparoscopy as a less invasive approach, while still enabling maximal tumor debulking. The aim of this study is to compare the short-term outcomes of laparoscopic CRS (L-CRS) and open cytoreductive surgery (O-CRS) with or without HIPEC, using propensity score matching analysis.

This retrospective, single-center study analyzed data from 364 patients who underwent CRS + HIPEC for a primary peritoneal tumor or with peritoneal carcinomatosis from various origins between January 2016 and December 2023. A propensity score matching (PSM) analysis included the surgical technique (Open-CRS vs. Laparoscopic-CRS) as the dependent variable and baseline characteristics as covariates in a logistic regression model. The two postmatching groups, O-CRS and L-CRS, were compared regarding intraoperative and short-term postoperative outcomes.

There were no significant differences in operative time (L-CRS/HIPEC: 372 min vs. O-CRS/HIPEC: 457 min; p = 0.754). Complete cytoreduction (CC-0) was achieved in all patients in both groups. L-CRS/HIPEC patients showed faster oral intake (2 days vs. 3 days; p = 0.035), the earlier passage of first flatus (3 days vs. 5 days; p = 0.043), shorter hospital stay (5 days vs. 7 days; p = 0.047), and quicker recovery to chemotherapy (29 days vs. 43 days; p = 0.024).

L-CRS offers selected patients a faster clinical recovery, shorter hospital stay, and quicker return to systemic chemotherapy. Nonetheless, prospective randomized trials are necessary to establish robust selection criteria and to evaluate the long-term oncological outcomes.