Role of diagnostic laparoscopy in preoperative staging and resectability assessment for cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy in peritoneal metastasis: a review

Abstract

Introduction:  Diagnostic laparoscopy (DL) is increasingly used in the preoperative evaluation of patients with peritoneal metastasis (PM) who are considered for cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC). Cross-sectional imaging has limited accuracy for assessing small-bowel and mesenteric disease, which are key determinants of resectability. DL may improve patient selection and reduce nontherapeutic laparotomy.
Aim:    We aimed to summarize current evidence on the feasibility, diagnostic performance, and clinical impact of DL in patients with PM undergoing qualification for CRS-HIPEC.
Materials and methods:        A narrative review of the literature was conducted. The studies were identified through the searches of the PubMed, MEDLINE, and Scopus databases, and supplemented by manual reference screening. Eligible publications included prospective and retrospective cohorts, multicenter studies, diagnostic accuracy trials, and reviews reporting outcomes of DL for CRS-HIPEC. The data were synthesized thematically. No meta-analysis was performed.
Results:           A total of 29 studies were included. Across 3632 procedures, DL was successfully completed in 98.3% of the patients. As many as 1034 individuals (28.5%) were excluded from CRS-HIPEC based on laparoscopic findings. Reduction in futile laparotomy was reported across various tumor types, including colorectal metastasis (approximately 12%–17%), gastric cancer (approximately 30%), and ovarian cancer (approximately 58%, when combined with computed tomography findings). Peritoneal Cancer Index underestimation occurred in 40%–63% of the mixed cohorts, mainly due to limited visualization of the small bowel. Positive predictive value for complete cytoreduction ranged from 80% to 95%. Major morbidity was below 2% in most series.
Conclusions::   DL is a safe and accurate staging tool that improves patient selection for CRS-HIPEC, reduces nontherapeutic laparotomy, and supports timely initiation of appropriate therapy. It should be considered a key component of contemporary staging pathways for PM.