[Diagnostic laparoscopy for peritoneal carcinomatosis-Why repeat laparoscopy often remains indispensable]

Peritoneal carcinomatosis (PC) remains associated with a poor prognosis; however, for selected patients, cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) can provide a potentially curative approach if complete cytoreduction (CCR) can be achieved. Diagnostic laparoscopy (LSK) is the key tool for selecting appropriate patients.

The aim of this study was to evaluate the informational quality of externally performed diagnostic LSK in patients with PC with respect to making decisions on CRS and HIPEC.

In this prospective single-center observational study, 42 patients with PC and potentially achievable CCR were included. Original operative reports from external LSK were obtained. If external LSK was inconclusive, repeat laparoscopy was performed. The findings from external laparoscopies were compared with those obtained from laparoscopies performed at our center.

Prior operative staging had been performed externally in 30/42 patients. The peritoneal cancer index (PCI) was documented in only 11.4% of cases. Photographic documentation was available in 22.9% of cases. In most reports no information was provided on small bowel involvement, Douglas pouch involvement or other critical tumor locations. In contrast, in-house LSK documented the PCI in 97.5% of cases and included photographic documentation in 77.5%.

Inadequate assessment and documentation of laparoscopies performed externally for the evaluation of PC generally does not enable reliable decision-making regarding CRS and HIPEC. Standardized reporting protocols developed in collaboration with CRS centers are needed. Until then, repeat LSK remains essential to avoid overtreatment and undertreatment.