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Posted by on May 13, 2013 in Colorectal cancer | 0 comments

In a nutshell

This article evaluated whether the use of a minimally invasive diagnostic technique called laparoscopy before surgery to treat peritoneal carcinomatosis improves the selection of patients who can benefit the most from treatment. The authors of the study found that laparoscopy can be used to select patients for whom surgery may be a possible curative treatment.

Some background

Peritoneal carcinomatosis is a medical term used when cancers have spread from the colon, appendix, or rectum to the peritoneum (a sheath that covers the abdominal organs). This type of cancer is often harder to treat because of the large surface it has spread to. A curative treatment needs the complete removal of the cancer during surgery (a procedure known as cytoreductive surgery or CS) and an additional chemotherapy treatment which is supposed to kill whatever cancer cells the surgeon missed. This chemotherapy is called hyperthermic intraperitoneal chemotherapy (HIPEC). HIPEC in given during surgery and it involves washing the abdominal cavity with a warm solution of chemotherapy. The outcome of this procedure depends on how spread the cancer is in the abdominal cavity. In order to determine this, the surgeon can perform a laparoscopy (the surgeon makes a small incision in the abdomen and uses a thin tube with a camera which translates into the surgeons eyes for a better view of the abdominal cavity).

Methods & findings

Two groups of patients were included in this study. The first group included 70 patients who did not have laparoscopy before surgery. A second group of 45 patients were evaluated using laparoscopy to identify if CS with HIPEC was an appropriate treatment for them.  
Results showed that out of the 70 patients in the first group only 39 (56%) underwent CS followed by HIPEC. Laparoscopy in the second group of patients spared 18 patients from a potentially unsuccessful surgery due to the cancer being too extensive. The addition of laparoscopy before surgery in the second group increased the number of patients who completed treatment with CS and HIPEC from 56% to 70%.

The bottom line

In summary, this article showed that laparoscopy was successfully used as a diagnostic tool in selecting patients with peritoneal carcinomatosis for a potentially curative treatment. 

The fine print

This study included a small group of patients. Larger studies are needed to confirm the results of this research. 

Published By :

British Journal of Surgery

Date :

Jan 01, 2013

Original Title :

Value of laparoscopy before cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis

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