Laparoscopic cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in gastrointestinal malignancy

Background: We aimed to evaluate laparoscopic cryoreductive surgery/hyperthermic intraperitoneal chemotherapy for patients with gastrointestinal malignancy and peritoneal carcinomatosis. Methods: This is a single surgeon case series of laparoscopic HIPEC procedures from 2013-2018. Inclusion criteria were diagnosis of GI malignancy with PC or high risk of developing PC after primary tumor resection. Outcomes analyzed included completeness of cytoreduction (CC), postoperative complications, and mortality. Results: Three patients with GI malignancy underwent laparoscopic HIPEC [2 males, 1 female; median age: 43 (20-50) years]. Mean BMI was 21.7 +- 1.3 kg/m2 and none had major comorbidities; one patient received preoperative chemotherapy. Two patients had mucinous appendiceal cystoadenocarcinoma and one had cecal adenocarcinoma. Two patients underwent right hemicolectomy with ileocolic anastomosis and one underwent total colectomy with ileorectal anastomosis. All patients had intraperitoneal peritoneal cancer index (PCI) scores <10 with completeness of cytoreduction (CC = 0 or 1). Mitomycin C was the chemotherapy agent used in all procedures. Median operative time was 7.5 (6.1-9.9) hours. There were no major intra/postoperative complications. Median length of stay was 4 (3-5) days. Mean overall survival was 31 (6-66) months with no mortality. One recurrence was detected at median follow-up of 19 (6-50) months. Conclusions: CS and HIPEC is associated with significant morbidity and mortality; laparoscopic CRS/HIPEC for GI malignancy may be feasible and safe in highly selected patients.