The INDEPSO-ISPSM Consensus on Peritoneal Malignancies-Minimally Invasive Surgery for Peritoneal Malignancies

Area of Science:

• Surgical Oncology
• Minimally Invasive Surgery
• Peritoneal Malignancies

Background:

• Cytoreductive surgery (CRS) for peritoneal malignancies traditionally uses large incisions.
• Minimally invasive approaches (MI-CRS) are emerging for selected patients with limited peritoneal spread.
• Evidence for MI-CRS is limited, necessitating expert consensus.

Purpose of the Study:

• To establish recommendations for minimally invasive cytoreductive surgery (MI-CRS).
• To provide guidance on staging laparoscopy and MI-CRS techniques.
• To address patient selection criteria for MI-CRS.

Main Methods:

• Modified Delphi technique employed for consensus-building.
• 23 questions addressed across staging laparoscopy and MI-CRS.
• 56 surgeons participated, with consensus defined as >70% agreement.

Main Results:

• Consensus reached on 18/23 questions (78.2%).
• Strong consensus (>90%) achieved on key aspects.
• MI-CRS contraindicated with incomplete staging, PCI > 10, extensive prior surgery, large masses, diaphragmatic/mesenteric involvement.

Conclusions:

• Recommendations established for staging laparoscopy and MI-CRS.
• Incomplete staging laparoscopy is a contraindication for MI-CRS.
• Further collaborative studies are needed to address remaining questions regarding MI-CRS.