Haythem Najah1,2, Réa Lo Dico3,4, Marion Grienay5, Anthony Dohan4,6, Xavier Dray7, Marc Pocard3,4. 1. Department of Oncologic and Digestive Surgery, Hôpital Lariboisière-AP-HP, 2 rue Ambroise Paré, 75475, Paris Cedex 10, France. haythem.najah@gmail.com. 2. Sorbonne Paris Cité, CART, INSERM U965, Université Paris Diderot, 74575, Paris, France. haythem.najah@gmail.com. 3. Department of Oncologic and Digestive Surgery, Hôpital Lariboisière-AP-HP, 2 rue Ambroise Paré, 75475, Paris Cedex 10, France. 4. Sorbonne Paris Cité, CART, INSERM U965, Université Paris Diderot, 74575, Paris, France. 5. Department of Anesthesiology, Hôpital Lariboisière-AP-HP, 2 rue Ambroise Paré, 75475, Paris Cedex 10, France. 6. Department of Abdominal Imaging, Hôpital Lariboisière-AP-HP, 2 rue Ambroise Paré, 75475, Paris Cedex 10, France. 7. Department of Gastroenterology, Hôpital Lariboisière-AP-HP, 2 rue Ambroise Paré, 75475, Paris Cedex 10, France.
Abstract
OBJECTIVE: To show the feasibility and the safety of peritoneal carcinomatosis (PC) evaluation by single-incision flexible endoscopy (SIFE) and to compare it to single-incision rigid endoscopy (SIRE). BACKGROUND: Direct peritoneal visualization, either by laparotomy or laparoscopy, continues to be the gold standard in diagnosing PC. We reported, in animal study, that combining single-incision laparoscopic surgery and flexible endoscopy improved evaluation of the peritoneal cavity in a live porcine model and in four human cadavers. METHODS: Patients, undergoing surgical exploration for diagnosis and staging of PC, were included in a prospective study. Using a superiority design a sample size of 47 patients was determined. Through a single incision, a standardized peritoneoscopy was conducted with rigid (SIRE) and with flexible endoscope (SIFE). Primary outcome was the access success rates for the 13 regions of the Peritoneal Carcinomatosis Index (PCI). RESULTS: Overall access to the 13 regions of PCI was successful in 83 % of the cases with SIRE and in 91.1 % with SIFE (p < 10(-10)). SIFE access rates were superior to SIREs' in the regions: R1 (87.2 vs. 61.7 %, p = 0.002), R2 (87.2 vs. 66 %, p = 0.004), R3 (85.1 vs. 59.6 %, p = 0.001) and R6 (80.9 vs. 61.7 %, p = 0.008). The mean PCI was higher (p < 10(4)) with SIFE 12.77 (±11.97) than with SIRE 11.77 (±11.63). CONCLUSION: This prospective, comparative study shows that SIFE was significantly superior to SIRE in the exploration of some difficult-to-access peritoneal areas, located in regions 1, 2, 3 and 6. These two minimally invasive staging procedures are safe, feasible and have to be seen as complementary rather than competing.
OBJECTIVE: To show the feasibility and the safety of peritoneal carcinomatosis (PC) evaluation by single-incision flexible endoscopy (SIFE) and to compare it to single-incision rigid endoscopy (SIRE). BACKGROUND: Direct peritoneal visualization, either by laparotomy or laparoscopy, continues to be the gold standard in diagnosing PC. We reported, in animal study, that combining single-incision laparoscopic surgery and flexible endoscopy improved evaluation of the peritoneal cavity in a live porcine model and in four human cadavers. METHODS:Patients, undergoing surgical exploration for diagnosis and staging of PC, were included in a prospective study. Using a superiority design a sample size of 47 patients was determined. Through a single incision, a standardized peritoneoscopy was conducted with rigid (SIRE) and with flexible endoscope (SIFE). Primary outcome was the access success rates for the 13 regions of the Peritoneal Carcinomatosis Index (PCI). RESULTS: Overall access to the 13 regions of PCI was successful in 83 % of the cases with SIRE and in 91.1 % with SIFE (p < 10(-10)). SIFE access rates were superior to SIREs' in the regions: R1 (87.2 vs. 61.7 %, p = 0.002), R2 (87.2 vs. 66 %, p = 0.004), R3 (85.1 vs. 59.6 %, p = 0.001) and R6 (80.9 vs. 61.7 %, p = 0.008). The mean PCI was higher (p < 10(4)) with SIFE 12.77 (±11.97) than with SIRE 11.77 (±11.63). CONCLUSION: This prospective, comparative study shows that SIFE was significantly superior to SIRE in the exploration of some difficult-to-access peritoneal areas, located in regions 1, 2, 3 and 6. These two minimally invasive staging procedures are safe, feasible and have to be seen as complementary rather than competing.
Authors: O Glehen; D Osinsky; E Cotte; F Kwiatkowski; G Freyer; S Isaac; V Trillet-Lenoir; A C Sayag-Beaujard; Y François; J Vignal; F N Gilly Journal: Ann Surg Oncol Date: 2003-10 Impact factor: 5.344
Authors: Dhruvil P Gandhi; Madhu Ragupathi; Chirag B Patel; Diego I Ramos-Valadez; T Bartley Pickron; Eric M Haas Journal: J Gastrointest Surg Date: 2010-10-05 Impact factor: 3.452
Authors: O Glehen; F Kwiatkowski; P H Sugarbaker; D Elias; E A Levine; M De Simone; R Barone; Y Yonemura; F Cavaliere; F Quenet; M Gutman; A A K Tentes; G Lorimier; J L Bernard; J M Bereder; J Porcheron; A Gomez-Portilla; P Shen; M Deraco; P Rat Journal: J Clin Oncol Date: 2004-08-15 Impact factor: 44.544