title: Incorporation of diagnostic laparoscopy in the management algorithm for patients with peritoneal metastases: A multi-institutional analysis.
abstract: BACKGROUND
  Diagnostic laparoscopy (DL), which can predict complete cytoreduction (CC), is often considered unfeasible in patients with Peritoneal metastases (PM) due to a hostile abdomen, prior surgeries, incomplete assessment or risk of port site recurrence. We hypothesized that DL can be successfully incorporated into the management of patients with PM.
  
  
  METHODS
  Retrospective review and data analysis of prospectively maintained databases from two high volume institutions was performed between 2007 and 2013.
  
  
  RESULTS
  DL was successfully completed in 211/217 (92.6%) patients with PM. The technique for entry was the Hasson in 57%, optical trocar in 38% and Veress needle in 5%. Serosal injury from DL occurred in one patient (0.4%). Predominant histology included appendiceal (40%) and colorectal primaries (34%). Exclusion from cytoreduction by DL occurred in 68 (31.3%). Among those excluded, 7 (of 68, 10.3%) subsequently underwent CRS + HIPEC after receiving systemic chemotherapy. Overall survival (from laparoscopy) for those that underwent CRS + HIPEC at the original operation was 36 versus 12.7 months among those who were excluded by laparoscopy. There were no cases of port site recurrence.
  
  
  CONCLUSIONS
  Diagnostic laparoscopy can be safely incorporated in the management of patients with peritoneal metastases, and can be especially beneficial in excluding patients from attempted incomplete cytoreduction.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Mount Sinai Medical Center, New York City, New York.
authors.forename: Parissa
authors.initials: P
authors.lastname: Tabrizian
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Thejus T
authors.initials: TT
authors.lastname: Jayakrishnan
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Anthony
authors.initials: A
authors.lastname: Zacharias
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Mount Sinai Medical Center, New York City, New York.
authors.forename: Samantha
authors.initials: S
authors.lastname: Aycart
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Fabian M
authors.initials: FM
authors.lastname: Johnston
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Mount Sinai Medical Center, New York City, New York.
authors.forename: Umut
authors.initials: U
authors.lastname: Sarpel
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Mount Sinai Medical Center, New York City, New York.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Labow
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Kiran K
authors.initials: KK
authors.lastname: Turaga
mesh_terms: D000465:Algorithms; D000970:Antineoplastic Agents / Q000008:administration & dosage; D065426:Cytoreduction Surgical Procedures; D016208:Databases, Factual; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D007263:Infusions, Parenteral; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010534:Peritoneal Neoplasms / Q000175:diagnosis* / Q000556:secondary / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents
keywords: CRS-HIPEC; diagnostic laparoscopy; outcome; peritoneal metastasis