Can a Minimally Invasive Procedure Help Determine Who Should Have CRS/HIPEC?
- 1 day ago
- 3 min read
For patients with peritoneal metastases (cancer that has spread to the lining of the abdomen), one of the biggest challenges is determining who is most likely to benefit from cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC). A new review highlights the growing role of diagnostic laparoscopy—a minimally invasive procedure that allows surgeons to look inside the abdomen before committing patients to major surgery.
Why is this important?
CRS/HIPEC is a complex operation that can significantly improve outcomes for carefully selected patients. However, not everyone with peritoneal metastases is a good candidate.
Standard imaging tests such as CT scans, MRI, and PET scans can miss small areas of cancer—particularly on the small bowel and its supporting tissue (the mesentery). If cancer is more extensive than expected, surgeons may begin a major operation only to discover that complete tumor removal isn't possible.
Diagnostic laparoscopy can help identify these patients before they undergo a large operation.
What did the researchers review?
Researchers analyzed 29 published studies involving 3,632 diagnostic laparoscopies performed in patients being evaluated for CRS/HIPEC.
The review included patients with several types of abdominal cancers, including:
Other peritoneal surface cancers
What did they find?
Diagnostic laparoscopy is very safe.
Researchers found:
98.3% of procedures were completed successfully.
Serious complications occurred in less than 2% of patients.
Death related to the procedure was extremely rare or absent across studies.
It helps doctors choose the right patients for CRS/HIPEC.
Nearly 29% of patients were found to have disease that was too extensive for CRS/HIPEC after laparoscopy. This allowed patients to avoid a major surgery that was unlikely to help and instead begin other appropriate treatments sooner.
It reduces unnecessary surgeries.
The review found diagnostic laparoscopy reduced "open-and-close" surgeries—operations that begin with the intention of performing CRS but are stopped because the cancer cannot be safely removed.
Examples included:
About 12–17% fewer unnecessary laparotomies in colorectal cancer.
About 30% fewer unnecessary surgeries in gastric cancer.
Up to 58% reduction when combined with CT imaging for ovarian cancer.
It improves surgical planning.
Although laparoscopy may slightly underestimate the total amount of cancer—especially on the small bowel—it was highly accurate at determining whether a patient was likely to achieve a complete cytoreduction (CC-0 or CC-1), the goal of CRS/HIPEC.
Across studies:
Positive predictive value for successful complete cytoreduction ranged from 80–95%.
Pooled diagnostic sensitivity was 98%.
Diagnostic specificity was 84%.
Why does this matter for patients?
For many patients, the goal isn't simply having surgery—it's having the right surgery at the right time.
This review suggests that diagnostic laparoscopy can help physicians:
Better determine whether CRS/HIPEC is likely to be successful.
Avoid major operations that are unlikely to benefit the patient.
Preserve quality of life by reducing unnecessary surgery.
Help patients move more quickly to chemotherapy or other treatments when surgery isn't appropriate.
Improve the chances of achieving a complete cytoreduction in patients who do proceed to CRS/HIPEC.
The proposed treatment pathway illustrates how diagnostic laparoscopy fits between imaging and treatment decisions, particularly when CT findings are uncertain or when there is concern about small bowel involvement.
What this means for patients
If your surgeon recommends a diagnostic laparoscopy before CRS/HIPEC, it does not necessarily mean your cancer has progressed or that surgery won't happen.
Instead, it is another tool that helps your care team gather the most accurate information possible before performing one of the most extensive cancer operations available.
By improving patient selection, diagnostic laparoscopy helps ensure that patients most likely to benefit from CRS/HIPEC receive it while helping others avoid unnecessary surgery.
Study limitations
Although this review included a large number of patients, there are important limitations:
It is a review of previously published studies, not a new clinical trial.
Most included studies were retrospective.
Different cancer types and treatment centers used different protocols.
Laparoscopy can still underestimate disease involving the small bowel and mesentery, so surgeons combine its findings with imaging studies and clinical judgment before making treatment decisions.
The Bottom Line
Diagnostic laparoscopy is becoming an important part of evaluating patients with peritoneal metastases who are being considered for CRS/HIPEC. This minimally invasive procedure is safe, highly accurate, and can help avoid unnecessary major surgery while improving the selection of patients most likely to benefit from cytoreductive surgery and HIPEC.