Robotic-assisted cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC): a minimally invasive approach for peritoneal carcinomatosis in patients with low burden disease.

INTRODUCTION: Peritoneal carcinomatosis (PC) presents a significant challenge and is often associated with poor prognosis. Cytoreductive surgery with heated intraperitoneal chemotherapy (CRS-HIPEC) stands as a well-established treatment modality for various forms of PC. The peritoneal cancer index (PCI) is used to assess the intraperitoneal disease burden, with evidence suggesting a linear correlation with overall survival, particularly in colorectal cancers with peritoneal metastasis. Similarly, completeness of cytoreduction (CC) is assessed post-resection to quantitatively measure residual disease in the abdomen. There has been a growing trend toward minimally invasive CRS-HIPEC, though achieving an accepted CC using this approach has been less frequently reported. This article describes the experience at our institution after ten cases of robotic-assisted CRS-HIPEC.

MATERIALS AND METHODS: Data from the ten consecutive R-CRS-HIPEC were retrospectively collected. Comprehensive preoperative imaging and multidisciplinary team deliberations were conducted for case selection. Mini-invasive robotic CRS-HIPEC was considered only for patients exhibiting a limited amount of PC, as evidenced by prior laparoscopy (PCI < 10). To compare surgical outcomes with a homogeneous population of patients undergoing open CRS and HIPEC, 18 consecutive patients treated in the pre-robotic era were retrospectively included, all with PCI < 10 and histology consistent with appendiceal-origin neoplasms.

RESULTS: No perioperative complications were noted, and all patients were discharged within seven days of the operation.

CONCLUSIONS: Robotic-assisted CRS-HIPEC for appendiceal mucinous neoplasms in highly selected patients is a safe and feasible procedure. A low intraperitoneal tumor burden in patients with intraperitoneal mucinous neoplasms emerges as a mandatory prerequisite to approach CRS-HIPEC with a robotic approach. We endorse ongoing investigation and future prospective clinical trials employing this technique.