Patient selection for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, and role of laparoscopy in diagnosis, staging, and treatment.

The indications for peritonectomy + hyperthermic intraperitoneal chemotherapy (HIPEC) are based on careful assessment of disease extent, but no imaging procedure is accurate enough to identify lesions smaller than 5 mm or extensively diffuse. Video-laparoscopy allows, with minimal surgical trauma, correct staging with a reliable prediction of expected cytoreduction index. Operative laparoscopy is indicated for palliation of neoplastic ascites with chemotherapy, offering encouraging results. Minimally invasive surgery in the treatment of minimal peritoneal carcinomatosis is not yet validated from wide international experience; the procedure is technically possible with strict indications, and combination with intraoperative hyperthermic chemotherapy is strongly recommended.