Robotic cytoreductive surgery and hyperthermic intra-peritoneal chemotherapy for selected appendiceal neoplasms: Early experience from a national referral centre.

Abstract

Background: Selected high-risk appendiceal neoplasms with tumour perforation or T4 disease may be considered for risk-reducing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC), even without overt radiological peritoneal disease. Since 2012, our centre has offered laparoscopic CRS-HIPEC, and a robotic approach was recently introduced to enhance visualisation, dexterity, and precision while minimising surgical trauma. This study evaluates the feasibility, safety, and early outcomes of risk-reducing robotic CRS-HIPEC (RCRS-HIPEC) in selected patients with high-risk appendiceal neoplasms without radiological peritoneal disease.

Patients and methods: This retrospective single-centre case series was conducted at a national referral centre for peritoneal surface malignancy. Eight patients underwent standardised RCRS-HIPEC. The cohort included low-grade appendiceal mucinous neoplasm ( n = 3), goblet cell carcinoma ( n = 4), and appendiceal adenocarcinoma ( n = 1). The standardised operative approach included omentectomy, falciform excision, umbilicectomy, and cholecystectomy or salpingo-oophorectomy where indicated, followed by closed HIPEC. Outcomes assessed included operative time, blood loss, complications, length of stay, histopathology, patient-reported recovery, and preliminary resource utilisation.

Results: Mean age was 65.8 years; there were 5 male and 3 female patients. Mean operative time was 6 h 19 min (±25 min), with minimal blood loss (<150 mL). No patient required epidural analgesia, parenteral nutrition, or prolonged critical care. Median time to first flatus was 3 days, and median hospital stay was 5 days. Two patients experienced Clavien-Dindo grade I morbidity, with no major complications. Histopathology demonstrated residual disease in two patients. Early electronic patient-reported outcome measures suggested favourable recovery, and preliminary Patient Level Information and Costing System data indicated potential NHS resource savings.

Conclusions: RCRS-HIPEC is feasible and safe in carefully selected patients with high-risk appendiceal neoplasms without radiological peritoneal disease. A standardised robotic approach may promote reproducibility, support enhanced recovery, and reduce healthcare resource use. Larger comparative studies are warranted.