Laparoscopy in the diagnosis and treatment of peritoneal metastases

Paul H. Sugarbaker


Over two decades the benefits of laparoscopy in the diagnosis and treatment of peritoneal metastases has been studied. Increasing utilization of this surgical tool has occurred with efficacy and safety demonstrated. The cancer surgery literature concerning the problem that peritoneal metastases presents, its adverse outcomes, and benefits of treatment were reviewed for patients with gastrointestinal malignancy. A major indication for laparoscopy is to determine the presence versus absence of peritoneal metastases. This may be especially important when planning treatments for gastric cancer. Repeated laparoscopy is used to monitor the efficacy of multiple cycles of intraperitoneal chemotherapy. Therapeutic laparoscopy involves the administration of hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with primary cancer who are at risk for subsequent peritoneal metastases or in those patients with peritoneal metastases diagnosed in follow-up. There are multiple applications of laparoscopy in patients with peritoneal metastases is indicated in many clinical situations as reviewed in this manuscript. Oftentimes, radiologic and laparoscopic assessments can be used to compliment each other.