title: Laparoscopic cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients with limited peritoneal surface malignancies: feasibility, morbidity and outcome in an early experience.
abstract: BACKGROUND
  Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are being widely used in the treatment of patients with peritoneal surface malignancies. The open procedure has been associated with high grade III and IV morbidity and prolonged hospitalization.
  
  
  METHODS
  Patients with peritoneal surface malignancies and no gross evidence of carcinomatosis on the computed tomographic scan were enrolled to undergo laparoscopic CRS and HIPEC. We aimed to assess the feasibility, safety, and outcome of this procedure. Postoperative complications were reported according to the National Cancer Institute Common Toxicity Criteria.
  
  
  RESULTS
  From October 2008 to January 2010, 14 patients were enrolled into the protocol. Amongst these 14 patients, one patient was found with extensive carcinomatosis at the time of laparoscopy and had no surgical procedure. Thirteen patients had a complete cytoreduction and HIPEC, 10 (77%) laparoscopically and 3 (23%) were converted to an open procedure. There was one grade 3 morbidity (10%) and one patient (10%) in the laparoscopy group experienced a grade 4 complication, needing a reoperation for an internal hernia. Mean length of hospital stay was 6 days for those completed laparoscopically, 8 days for those converted to an open procedure and 8 days for a matched cohort of patients with an upfront open procedure.
  
  
  CONCLUSIONS
  This initial investigative stage demonstrates the feasibility and safety of cytoreductive surgery and HIPEC via the laparoscopic route in selected patients with low-tumor volume and no small bowel involvement mainly from appendiceal malignancies. Longer follow-up and additional studies are required to evaluate its long-term efficacy.
authors.affiliation: St. Agnes Hospital, Baltimore, Maryland 21229, USA. jesusesquivel@yahoo.com
authors.forename: Jesus
authors.initials: J
authors.lastname: Esquivel
authors.forename: Andrew
authors.initials: A
authors.lastname: Averbach
authors.forename: Terence C
authors.initials: TC
authors.lastname: Chua
mesh_terms: D000368:Aged; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000379:methods*; D003131:Combined Modality Therapy; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007263:Infusions, Parenteral; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010534:Peritoneal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D018570:Risk Assessment; D017751:Safety Management; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome