Outcome of patients scheduled for CRS and HIPEC yet only undergoing explorative laparotomy

Background

Some patients scheduled for cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) only undergo explorative laparotomy (open/close procedure) due to extensive tumor spread or challenges in achieving complete cytoreduction (CC0). This study aimed to evaluate the surgical outcomes and overall survival in patients with peritoneal surface malignancy (PSM) who only undergo open/closed laparotomy.

Methods

All patients scheduled for CRS and HIPEC in Malmö, Sweden, between 2015 and 2023, who only underwent open/close laparotomy were included. Patients without malignant diagnoses were excluded. Clinical, survival, and complication data were analyzed.

Results

A total of 28 patients underwent open/closed laparotomy only. Before the laparotomy, 15 (54 ​%) patients had undergone diagnostic laparoscopy with a median PCI score of 13.0 (IQR 10.0–19.0). During the laparotomy, the median PCI score was found to be 29.0 (IQR 25.5–33.0). The most common reason for not proceeding with CRS and HIPEC surgery was a high PCI score (61 ​%). Three patients (11 ​%) experienced serious postoperative complications (Clavien-Dindo ≥3b), and one patient died during the first postoperative day. After the explorative laparotomy, twenty-one (78 ​%) patients received palliative chemotherapy (median survival of 13.4 months), whereas six received none (median survival of 3.5 months), with missing data from one patient.

Conclusion

Patients diagnosed with PSM who undergo only exploratory laparotomy (open/close) have a very poor prognosis. Exploratory laparotomy poses a significant risk of serious postoperative complications, as well as a lengthy hospital stay. Improved diagnostic tools are urgently needed to help identify the right patients for CRS and HIPEC treatment.