Laparoscopic cytoreductive surgery and HIPEC: a comparative matched analysis

• Published in: Surgical endoscopy Vol. 35; no. 4; pp. 1778 - 1785
• Main Authors: Rodríguez-Ortiz, L., Arjona-Sánchez, A., Ibañez-Rubio, M., Sánchez-Hidalgo, J., Casado-Adam, A., Rufián-Peña, S., Briceño-Delgado, J.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-04-2021; Springer Nature B.V
• Subjects: Abdominal Surgery; Chemotherapy; Gastroenterology; Gynecology; Hepatology; Laparoscopy; Medicine; Medicine & Public Health; Mortality; Proctology; Surgery; Minimally invasive surgery; Laparoscopy; HIPEC; Cytoreductive surgery
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-020-07572-x

Background
Cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) is a procedure that has had encouraging results for peritoneal metastases (PM) from diverse tumour origins, but it is not exempt from high morbidity. Recently, the important role of laparoscopy in oncologic surgeries and its benefits have been evaluated for CRS + HIPEC in selected patients, which has yielded promising results. The aim of our study is to analyse the use of laparoscopy for CRS + HIPEC in patients with limited peritoneal disease.
Methods
We have conducted a retrospective study from a prospective database in our tertiary referral hospital within the period of January 2009 to July 2019, which includes 825 patients who had PM from varying tumour origins. We have compared the patients treated with the laparoscopic approach (L-CRS-HIPEC) to a matched population who have undergone the open approach (O-CRS-HIPEC) and fulfil the same selection criteria. We have analysed the postoperative outcomes and survival results.
Results
We have confirmed the homogeneity between the sample of the O-CRS + HIPEC (
n
 = 42) and the L-CRS + HIPEC (
n
 = 18) regarding preoperative and intraoperative features. The L-CRS + HIPEC group had shorter hospital stays, (median of 4 [2–10] days versus 9 [2–19] days) and reduced wait time to return to chemotherapy (median of 4 [3–7] weeks and a median of 8 [4–36] weeks) than the O-CRS + HIPEC group. No differences were found regarding the need for perioperative blood transfusion, surgery time or postoperative morbi-mortality. No early locoregional relapse occurred in the L-CRS + HIPEC group and short term disease-free survival did not differ between groups.
Conclusions
Laparoscopy for CRS + HIPEC is feasible and safe in highly selected patients, with no significant differences concerning postoperative morbi-mortality or early oncological results. We have found that patients who have undergone laparoscopic operations have shorter hospital stays and that they return to adjuvant chemotherapy sooner. Further investigation is required to confirm the benefits of minimally invasive procedures for the management of PM.