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Shaltiel T, Solomon D, Pletcher ER, Golas BJ, Magge DR, Sarpel U, Labow DM, Cohen NA. Laparoscopic cytoreductive surgery and hyperthermic intraperitoneal chemotherapy is associated with improved perioperative outcomes: a single-center early experience propensity-matched analysis. Surg Endosc 2022; 36:6153-6161. [PMID: 35080674 DOI: 10.1007/s00464-022-09034-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 01/03/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The role of laparoscopy in cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is not well established. Herein, we describe our early experience of laparoscopic CRS/HIPEC in patients with low-volume peritoneal disease compared to patients who underwent open CRS/HIPEC during the same time period. METHODS Using a prospectively maintained database, patients who underwent laparoscopic CRS/HIPEC were compared to a control cohort of patients who underwent open CRS/HIPEC, matched for peritoneal carcinomatosis index (PCI), completeness of cytoreduction, and tumor histology. RESULTS Between 2008 and 2017, 16 patients underwent laparoscopic CRS/HIPEC and were compared to a matched control cohort of 32 patients who underwent open CRS/HIPEC. Clinical and demographic data were similar between the groups. PCI, number of resected organs, and optimal cytoreduction rates were comparable. Patients who underwent laparoscopic experienced a lower estimated blood loss, (median, [IQR 1-3]); 150 mL, [50-300] vs. 100 mL, [50-125], p = 0.04, shorter length of stay (median [IQR 1-3]; 4 days [3-6] vs. 6 days [5-8], p < 0.01, and a lower 30-day complication rate (6.3% vs. 56.3%, p < 0.01). There was no difference in progression-free survival (p = 0.577) and overall survival (p = 0.472) between the groups. CONCLUSIONS This preliminary study demonstrates that laparoscopic CRS/HIPEC is feasible and safe for curative treatment in selected patients with low tumor volume. Minimally invasive CRS/HIPEC is associated with fewer postoperative complications and shorter length of stay. There was no difference in long-term oncological outcomes between the groups.
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Affiliation(s)
- Tali Shaltiel
- Division of Surgical Oncology Division, Department of Surgery, Icahn School of Medicine at Mount Sinai Medical Center, E. 98th Street. Suite 7A, Box 1103, New York, NY, 10029, USA
| | - Daniel Solomon
- Division of Surgical Oncology Division, Department of Surgery, Icahn School of Medicine at Mount Sinai Medical Center, E. 98th Street. Suite 7A, Box 1103, New York, NY, 10029, USA
| | - Eric R Pletcher
- Division of Surgical Oncology Division, Department of Surgery, Icahn School of Medicine at Mount Sinai Medical Center, E. 98th Street. Suite 7A, Box 1103, New York, NY, 10029, USA
| | - Benjamin J Golas
- Division of Surgical Oncology Division, Department of Surgery, Icahn School of Medicine at Mount Sinai Medical Center, E. 98th Street. Suite 7A, Box 1103, New York, NY, 10029, USA
| | - Deepa R Magge
- Division of Surgical Oncology Division, Department of Surgery, Icahn School of Medicine at Mount Sinai Medical Center, E. 98th Street. Suite 7A, Box 1103, New York, NY, 10029, USA
| | - Umut Sarpel
- Division of Surgical Oncology Division, Department of Surgery, Icahn School of Medicine at Mount Sinai Medical Center, E. 98th Street. Suite 7A, Box 1103, New York, NY, 10029, USA
| | - Daniel M Labow
- Division of Surgical Oncology Division, Department of Surgery, Icahn School of Medicine at Mount Sinai Medical Center, E. 98th Street. Suite 7A, Box 1103, New York, NY, 10029, USA
| | - Noah A Cohen
- Division of Surgical Oncology Division, Department of Surgery, Icahn School of Medicine at Mount Sinai Medical Center, E. 98th Street. Suite 7A, Box 1103, New York, NY, 10029, USA.
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