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Background: The outcome of cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC) depends on the extent of peritoneal carcinomatosis. The role of laparoscopy in the preoperative assessment of extent of peritoneal carcinomatosis in potential candidates for cytoreductive surgery and HIPEC was evaluated in a consecutive series., Methods: Patients with peritoneal carcinomatosis from colorectal cancer or appendiceal cancer, pseudomyxoma peritonei or peritoneal mesothelioma referred to a single, national HIPEC centre were included prospectively between June 2006 and January 2012. From September 2010, preoperative evaluation also included a laparoscopy in patients deemed amenable to cytoreductive surgery and HIPEC after radiological evaluation, apart from those with pseudomyxoma peritonei with massive amounts of mucin., Results: In the period before laparoscopic evaluation, 70 patients underwent laparotomy of whom 39 (56 per cent) completed cytoreductive surgery and HIPEC. After the introduction of laparoscopic assessment, diagnostic laparoscopy was planned in 45 patients and successful in 43. The laparoscopic evaluation excluded 18 patients from surgery because of extensive disease, among other reasons. Laparoscopy was uneventful and associated with no deaths. Twenty-seven patients were considered amenable to cytoreductive surgery and HIPEC based on laparoscopic findings, of whom 17 completed this treatment; the disease was unresectable in the remaining ten patients. Of 13 patients who were not eligible for laparoscopic evaluation and were subjected to cytoreductive surgery plus HIPEC, 11 completed the procedure. The overall completion rate of cytoreductive surgery and HIPEC increased to 70 per cent (28 of 40) after the introduction of laparoscopic evaluation., Conclusion: Diagnostic laparoscopy was valuable in preoperative evaluation of the extent of peritoneal carcinomatosis, and improved patient selection for cytoreductive surgery and HIPEC., (Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.)

Peritoneal carcinomatosis (PC) is commonly seen in colorectal cancer and is uniformly fatal. Cytoreductive surgery (CS) combined with hyperthermic intraperitoneal chemotherapy (HIIC) is a new treatment in strictly selected patients with PC. CS includes peritonectomy procedures and resection of infiltrated viscera leaving no macroscopic tumor thicker than 2.5 mm behind. Peritoneal perfusion with mitomycin C at a temperature of 40 degrees -41 degrees C is performed at the end of surgery. The postoperative morbidity and mortality rates are 20%-30% and 4%-8% respectively. Median survival is 1-2 years and the 5-year survival is 19%.

We recommend that in the future, surgery for colorectal cancer (CRC) in Denmark should be done in 10 to 15 colorectal units with an uptake zone of 350,000-500,000 citizens each. These units should perform both acute and elective CRC surgery and acute surgical treatment of other intestinal diseases. In each unit, a senior colorectal surgeon should be available on a 24-hour shift, and there should be sufficient diagnostic and theatre capacity to ensure optimal treatment levels. A stoma clinic should be available Monday to Friday. The units should perform research according to international standards. Each senior surgeon should document his or her relevant continuing surgical education. A national postgraduate education should be ensured to all members of the multidisciplinary team according to the standards in force in Great Britain. The treatment of primary advanced T4 tumors and local recurrence should be done in only one to two colorectal units in Denmark, and the treatment of local recurrence with spread to the pelvis should be done in only one unit in Denmark.