Cytoreductive Surgery and Peritonectomy Procedures

Abstract

Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has become widely accepted as an effective method of treating peritoneal metastases (PM) from various cancers. CRS performed with the goal of removing all the macroscopic disease and comprises of peritonectomy procedures and visceral resections. CRS is a technically challenging surgery that requires a considerable amount of skill and appropriate patient selection. This article is a review of the techniques and current recommendations for performing CRS.

Keywords: Cytoreductive surgery; Multi-organ resection; Pelvic peritonectomy; Peritonectomy; Subphrenic peritonectomy; Techniques of cytoreductive surgery.

Fig. 1

Peritoneal carcinomatosis index (PCI)

Fig. 2

Anterolateral parietal peritonectomy

Fig. 3

Subphrenic peritonectomy – peritoneum dissected off the diaphragm on either sides

Fig. 4

Completed right subphrenic peritonectomy

Fig. 5

Base of the right subphrenic peritonectomy and subhepatic space; 5a – before; 5b - after

Fig. 6

Finger dissection to strip off the Glisson’s capsule

Fig. 7

Completed Glisson’s capsule stripping

Fig. 8

Left subphrenic peritonectomy

Fig. 9

Lesser sac dissection – note the pancreatic capsule being stripped off to clear the deposits in the lesser sac following a previous attempt at cytoreduction with recurrent lesions in the lesser sac

Fig. 10

Lesser omentectomy and hepatoduodenal ligament clearance; 10a – before; 10b – after

Fig. 11

Divided Pont Hepatique exposing the umbilical ligament

Fig. 12

Rectum preserving pelvic peritonectomy

Fig. 13

Pelvic peritonectomy with anterior resection below the reflection of the pouch of Douglas

Fig. 14

Localized peritonectomy over mesentry to remove a mesenteric deposit