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

Cytoreductive surgery (CRS) for peritoneal malignancies is conventional performed employing a large incision from the xiphisternum to the pubis. Recent publications have suggested a minimally invasive approach to achieve similar outcomes in patients with limited peritoneal cancer spread. This manuscript reports the results of a consensus exercise that aimed to provide recommendations on minimally invasive cytoreductive surgery (MI-CRS) for which evidence is limited. The consensus was carried out using the modified Delphi technique. There were 23 questions on two main topics: staging laparoscopy and minimal invasive cytoreductive surgery. A total of 56/62 invited surgeons agreed to vote on the consensus. A consensus was achieved if any option received > 70% of votes, and a strong consensus was set at > 90%. In rounds I and II both, 50/56 (89.28%) panellists voted. Overall, a consensus was achieved on 18/23 (78.2%) questions (strong consensus on 17.3%). The panel strongly recommended that MI-CRS should not be performed if there is incomplete evaluation during the staging laparoscopy. The panel considered PCI > 10, previous extensive abdominal surgery, large intraabdominal masses, gross diaphragmatic involvement and multi-focal mesenteric disease as contraindications to MI-CRS. There was no consensus obtained on the technique of HIPEC after MI-CRS and on performing MI-CRS in high-grade tumours and after neoadjuvant chemotherapy in advanced ovarian cancer. This consensus laid down recommendations for technical aspects of staging laparoscopy and patient selection and technical aspects of MI-CRS. The results should spur more collaborative studies across the world to address key questions related to MI-CRS.

The online version contains supplementary material available at 10.1007/s13193-025-02271-2.