Diagnostic Laparoscopy as a Selection Tool for Patients with Colorectal Peritoneal Metastases to Prevent a Non-therapeutic Laparotomy During Cytoreductive Surgery

• Published in: Annals of surgical oncology Vol. 27; no. 4; pp. 1084 - 1093
• Main Authors: Hentzen, Judith E. K. R., Constansia, Reickly D. N., Been, Lukas B., Hoogwater, Frederik J. H., van Ginkel, Robert J., van Dam, Gooitzen M., Hemmer, Patrick H. J., Kruijff, Schelto
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-04-2020; Springer Nature B.V
• Subjects: Aged; Chemotherapy; Chemotherapy, Cancer, Regional Perfusion; Colorectal Neoplasms - mortality; Colorectal Neoplasms - pathology; Colorectal Neoplasms - therapy; Combined Modality Therapy; Cytoreduction Surgical Procedures; Female; Gastrointestinal Oncology; Hospital Mortality; Humans; Hyperthermic Intraperitoneal Chemotherapy; Laparoscopy; Laparoscopy - adverse effects; Laparoscopy - methods; Male; Medical records; Medicine; Medicine & Public Health; Metastases; Metastasis; Middle Aged; Oncology; Patients; Peritoneal Neoplasms - diagnosis; Peritoneal Neoplasms - mortality; Peritoneal Neoplasms - secondary; Peritoneal Neoplasms - therapy; Peritoneum; Peritoneum - pathology; Peritoneum - surgery; Postoperative Complications - etiology; Preoperative Care - adverse effects; Retrospective Studies; Surgery; Surgical Oncology; Survival
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-019-07957-w

Objective
The aim of this study was to evaluate the introduction of diagnostic laparoscopy (DLS) in patients with colorectal peritoneal metastases (PM) to prevent non-therapeutic laparotomies during cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS + HIPEC).
Methods
Patients with histologically proven colorectal PM who underwent a laparotomy for potential CRS + HIPEC from January 2006 to January 2019 were retrospectively identified from a prospectively maintained database. In 2012, DLS was introduced in the preoperative work-up for CRS + HIPEC in our academic center. The rates of non-therapeutic laparotomies, major postoperative complications (Clavien–Dindo grade III or higher), and survival outcomes were investigated for patients who underwent a laparotomy before (cohort A) and after (cohort B) the introduction of DLS. In cohort B, the reasons to refrain from DLS were retrospectively explored from medical records.
Results
Overall, 172 patients were included [cohort A: 48 patients (27.9%); cohort B: 124 patients (72.1%)]. A significant drop in the rate of non-therapeutic laparotomies occurred in cohort B compared with cohort A (21.0 vs. 35.4%:
p
 = 0.044), despite only 85 patients (68.5%) from cohort B undergoing DLS in our academic center. The most important reason to refrain from DLS was a recently performed DLS or laparotomy in the referring hospital (48.7%). Major postoperative complications, in-hospital mortality, and survival outcomes were similar for both cohorts.
Conclusions
Performing DLS during the preoperative work-up for CRS + HIPEC prevents non-therapeutic laparotomies in patients with colorectal PM. We recommend performing this laparoscopic screening in an experienced HIPEC center.