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<p>Cytoreductive surgery (CRS) for peritoneal malignancies is conventional performed employing a large incision from the xiphisternum to the pubis. Recent publications have suggested a minimally invasive approach to achieve similar outcomes in patients with limited peritoneal cancer spread. This manuscript reports the results of a consensus exercise that aimed to provide recommendations on minimally invasive cytoreductive surgery (MI-CRS) for which evidence is limited. The consensus was carried out using the modified Delphi technique. There were 23 questions on two main topics: staging laparoscopy and minimal invasive cytoreductive surgery. A total of 56/62 invited surgeons agreed to vote on the consensus. A consensus was achieved if any option received &gt; 70% of votes, and a strong consensus was set at &gt; 90%. In rounds I and II both, 50/56 (89.28%) panellists voted. Overall, a consensus was achieved on 18/23 (78.2%) questions (strong consensus on 17.3%). The panel strongly recommended that MI-CRS should not be performed if there is incomplete evaluation during the staging laparoscopy. The panel considered PCI &gt; 10, previous extensive abdominal surgery, large intraabdominal masses, gross diaphragmatic involvement and multi-focal mesenteric disease as contraindications to MI-CRS. There was no consensus obtained on the technique of HIPEC after MI-CRS and on performing MI-CRS in high-grade tumours and after neoadjuvant chemotherapy in advanced ovarian cancer. This consensus laid down recommendations for technical aspects of staging laparoscopy and patient selection and technical aspects of MI-CRS. The results should spur more collaborative studies across the world to address key questions related to MI-CRS.</p>

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The INDEPSO-ISPSM Consensus on Peritoneal Malignancies—Minimally Invasive Surgery for Peritoneal Malignancies

  • 期刊论文

  • 发表日期：

    2025年3月13日

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  • Vivek Sukumar,
  • Swapnil Patel,
  • Aditi Bhatt,
  • Manish Bhandare,
  • Ambarish Chatterjee,
  • Rohit Kumar,
  • Ajinkya Pawar,
  • Somashekhar SP,
  • Vivekanand Sharma,
  • Avanish Saklani,
  • Ramakrishnan Ayloor Seshadri

摘要

Cytoreductive surgery (CRS) for peritoneal malignancies is conventional performed employing a large incision from the xiphisternum to the pubis. Recent publications have suggested a minimally invasive approach to achieve similar outcomes in patients with limited peritoneal cancer spread. This manuscript reports the results of a consensus exercise that aimed to provide recommendations on minimally invasive cytoreductive surgery (MI-CRS) for which evidence is limited. The consensus was carried out using the modified Delphi technique. There were 23 questions on two main topics: staging laparoscopy and minimal invasive cytoreductive surgery. A total of 56/62 invited surgeons agreed to vote on the consensus. A consensus was achieved if any option received > 70% of votes, and a strong consensus was set at > 90%. In rounds I and II both, 50/56 (89.28%) panellists voted. Overall, a consensus was achieved on 18/23 (78.2%) questions (strong consensus on 17.3%). The panel strongly recommended that MI-CRS should not be performed if there is incomplete evaluation during the staging laparoscopy. The panel considered PCI > 10, previous extensive abdominal surgery, large intraabdominal masses, gross diaphragmatic involvement and multi-focal mesenteric disease as contraindications to MI-CRS. There was no consensus obtained on the technique of HIPEC after MI-CRS and on performing MI-CRS in high-grade tumours and after neoadjuvant chemotherapy in advanced ovarian cancer. This consensus laid down recommendations for technical aspects of staging laparoscopy and patient selection and technical aspects of MI-CRS. The results should spur more collaborative studies across the world to address key questions related to MI-CRS.