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L Messer, E Edhayan, R Berri
Ascension St. John Hospital and Medical Center

Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is the standard treatment for mucinous neoplasms of the appendix and is currently a potential treatment option for other select cancers. Our study examined the feasibility and technical challenges of treating a subset of patients with laparoscopic HIPEC. We also looked at the feasibility of a laparoscopic neoadjuvant HIPEC in downstaging gastric cancer with peritoneal metastasis.

A retrospective chart review of all adult patients who underwent laparoscopic HIPEC from January 1, 2013 to December 31, 2020 was conducted. Patient demographics, diagnosis, peritoneal carcinomatosis index (PCI), chemotherapy used, type of surgical resection, length of surgery, and outcomes including length of stay, morbidity, and mortality were collected.

Nine patients underwent a total of 14 Laparoscopic HIPEC operations. One patient underwent 5 Laparoscopic HIPEC before undergoing partial gastrectomy and open HIPEC. The mean PCI score was 5. Five patients had low grade mucinous neoplasm with perforation of the appendix, two patients had adenocarcinoma of the appendix, one had peritoneal papillary mesothelioma and one patient had stage 4 adenocarcinoma of the stomach. There were four patients who had Laparoscopic HIPEC only, while five had single or multi-visceral resections. There were no conversions to open procedures. The mean operative time was 5.5 hours. The mean length of stay was 3.7 days. The most common chemotherapy agents used were Mitomycin C and Cisplatin. There was no 90 day mortality nor readmissions. The patient with gastric cancer had downstaging of her disease followed by R0 gastric resection with open HIPEC.

Laparoscopic HIPEC is feasible for selected pathologies, low PCI scores and for neoadjuvant HIPEC to downstage positive peritoneal cytology before definitive therapy may be an option for highly selected patients.

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