Challenges of Nontherapeutic Laparotomy in Patients with Peritoneal Surface Malignancies Selected for Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy
by
, , , , , , and
Elena Gil-Gómez
1,†
,
Alida González-Gil
1,†,
Vicente Olivares-Ripoll
1,
Álvaro Cerezuela-Fernández de Palencia
1,
Francisco López-Hernández
1,
Álvaro Martínez-Espí
1,
Jerónimo Martínez-García
2,
Francisco Barceló
3,
Alberto Rafael Guijarro-Campillo
3 and
Pedro Antonio Cascales-Campos
1,4,* 1
Peritoneal Carcinomatosis and Sarcomas Unit, Department of Surgery, Hospital Universitario Virgen De La Arrixaca, IMIB-Arrixaca, 30120 Murcia, Spain
2
Department of Medical Oncology, Hospital Universitario Virgen De La Arrixaca, IMIB-Arrixaca, 30120 Murcia, Spain
3
Department of Gynecologic Oncology, Hospital Universitario Virgen De La Arrixaca, IMIB-Arrixaca, 30120 Murcia, Spain
4
Department of Surgery, University of Murcia, 30100 Murcia, Spain
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this work.
Cancers 2025, 17(9), 1445; https://doi.org/10.3390/cancers17091445
Submission received: 18 March 2025
/
Revised: 21 April 2025
/
Accepted: 24 April 2025
/
Published: 25 April 2025
(This article belongs to the Special Issue Advances in Abdominal Surgical Oncology and Intraperitoneal Therapies)
Simple Summary
This study analyzed outcomes in patients with peritoneal surface malignancies who were initially considered to be candidates for cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) but were found to have unresectable disease during exploratory laparotomy. Among 486 patients evaluated between 2008 and 2022, 46 (9.4%) procedures were aborted due to extensive disease, especially with massive small bowel involvement. The median surgery duration was 90 min. Postoperative complications occurred in 22% of cases, and the mortality rate was 4.3%. Survival was significantly lower in patients who did not receive palliative systemic chemotherapy (4 months vs. 15 months). The findings highlight that nontherapeutic exploratory laparotomies carry considerable risks. Therefore, improving preoperative staging with advanced technologies such as radiomics and laparoscopy is essential to reduce the number of patients undergoing unnecessary surgery when the disease is ultimately found to be unresectable.
Abstract
Background: This study aimed to analyze the morbidity, mortality, and survival outcomes in patients with peritoneal surface malignancies who were initially considered candidates for cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) but were found to have unresectable disease, resulting in nontherapeutic exploratory laparotomy. Patients and Methods: We evaluated data from our referral center for the treatment of peritoneal surface malignancies between January 2008 and December 2022. Adverse events following nontherapeutic laparotomy were classified using the National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.0. Results: Among a cohort of 486 patients with peritoneal surface malignancies initially considered candidates for CRS + HIPEC, 46 cases (9.4%) were aborted due to the disease being deemed unresectable during exploratory laparotomy. The primary reasons for unresectability included extensive disease spread, observed in 28 patients, with massive small intestine involvement detected in 13 of these cases. The median duration of surgery was 90 min (range: 60–180 min). Postoperative complications occurred in 10 patients (22%), with a mortality rate of 4.3% (2 patients). Survival was significantly lower in patients who did not receive adjuvant systemic chemotherapy with palliative intent (4 months vs. 15 months, p < 0.01). Conclusions: Exploratory laparotomy in patients with peritoneal surface malignancies considered for CRS with HIPEC carries a substantial risk of complications. Improved preoperative staging using advanced technologies such as radiomics and laparoscopy is expected to reduce the number of patients undergoing nontherapeutic laparotomy.
