Mario Valle1, Alfredo Garofalo. 1. Laparoscopic Unit, Department of Surgery, S. Camillo Hospital, Rome, Italy. mario.valle2@tin.it
Abstract
BACKGROUND: The Peritoneal Cancer Index (PCI) may be used in the intraoperative evaluation of peritoneal surface malignancies to estimate the feasibility of peritonectomy with intraperitoneal hyperthermic chemotherapy perfusion. Although radiologic imaging techniques detect liver and other distant metastases, they do not accurately image small cancer implants on small bowel and its mesentery, thus making a CT-PCI classification impossible. RESULTS: We used videolaparoscopy to stage 97 cases of peritoneal carcinomatosis, and achieved full laparoscopic PCI assessment in 96/97 cases, while only 2/96 cases were understaged. In all our cases where peritonectomy followed diagnostic laparoscopy, we found good correlation between the open surgery data and the laparoscopic PCI. There was no mortality and no neoplastic colonization at the trocar port site. We excluded patients from peritonectomy if the staging laparoscopy showed a massive involvement of their small bowel or mesentery. CONCLUSION: Laparoscopy is a useful tool in peritoneal surface malignancies; it allows direct visualization even of small cancer nodules and provides a reliable assessment of the feasibility of peritonectomy.
BACKGROUND: The Peritoneal Cancer Index (PCI) may be used in the intraoperative evaluation of peritoneal surface malignancies to estimate the feasibility of peritonectomy with intraperitoneal hyperthermic chemotherapy perfusion. Although radiologic imaging techniques detect liver and other distant metastases, they do not accurately image small cancer implants on small bowel and its mesentery, thus making a CT-PCI classification impossible. RESULTS: We used videolaparoscopy to stage 97 cases of peritoneal carcinomatosis, and achieved full laparoscopic PCI assessment in 96/97 cases, while only 2/96 cases were understaged. In all our cases where peritonectomy followed diagnostic laparoscopy, we found good correlation between the open surgery data and the laparoscopic PCI. There was no mortality and no neoplastic colonization at the trocar port site. We excluded patients from peritonectomy if the staging laparoscopy showed a massive involvement of their small bowel or mesentery. CONCLUSION: Laparoscopy is a useful tool in peritoneal surface malignancies; it allows direct visualization even of small cancer nodules and provides a reliable assessment of the feasibility of peritonectomy.
Authors: Haythem Najah; Réa Lo Dico; Marion Grienay; Anthony Dohan; Xavier Dray; Marc Pocard Journal: Surg Endosc Date: 2015-12-10 Impact factor: 4.584