Complete laparoscopic pelvic peritonectomy plus hyperthermic intraperitoneal chemotherapy

Techniques in Coloproctology 2020 October [Link]

A Arjona-Sánchez, D Cortés-Guiral, M Duran-Martínez, P Villarejo-Campos, J M Sánchez-Hidalgo, A Casado-Adam, L Rodriguez-Ortiz, A Romero-Ruiz, B Rufian-Andujar, E Espinosa-Redondo, F Valenzuela-Molina, S Rufián-Peña, J Briceño-Delgado


Background: The aim of our study was to present the technique for, and early results of complete laparoscopic pelvic peritonectomy (LPP) plus hyperthermic intraperitoneal chemotherapy (HIPEC).

Methods: We conducted a study on consecutive patients who had LPP for limited peritoneal carcinomatosis (peritoneal carcinomatosis index < 10) from ovarian cancer, colon cancer and benign multicystic mesothelioma, from January 2017 to November 2019 at 2 referral centers in Spain. Perioperative, pathologic, 30-day major morbidity and mortality characteristics were analyzed. The surgical technique is shown in the attached video.

Results: Twelve LPP + HIPEC were performed. Complete cytoreduction was achieved in 100% of the patients, the median duration of the operation was 450 min (range 360-600 min). There were 2 cases (16%) of IIIa morbidity (trocar hernia and pleural effusion), and no mortality. The median length of hospital stay was 5.5 days (range 4-10 days). The median length of follow-up was 10 months (range 2-30 months). There was a recurrence at the splenic hilum in 1 patient which was treated by laparoscopic splenectomy and one nodal recurrence at 13 months while all other patients are alive and free of disease at last follow-up.

Conclusions: This is the first technical video of a minimally invasive approach for complete pelvic peritonectomy plus omentectomy associated with HIPEC. For highly selected patients, this procedure presents a feasible and safe alternative to the maximally invasive approach.