Value of laparoscopy before cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis (Br J Surg 2013; 100: 285–292)

Cytoreductive surgery (CRS) followed by systemic chemotherapy has limited success in the treatment of peritoneal carcinomatosis. However, the addition of hyperthermic intraperitoneal chemotherapy (HIPEC) offers a new treatment option for low/moderate-volume disease in the peritoneal cavity. The complete surgical procedure is complicated, and resource- and time-consuming. Patient selection is crucial to restrict this complex and potentially toxic treatment to patients in whom complete cytoreduction is feasible. Different options have been focused on to reduce potentially expensive cancellations of surgery in the operating theatre; these include improvement of preoperative investigations and staging procedures, improved experience from large-volume centres, better evaluation by multidisciplinary teams, and increased experience from the performance of clinical studies. Radiological methods such as dedicated computed tomography, magnetic resonance imaging and positron emission tomography understage the small bowel, its mesentery and retroperitoneal involvement to a large extent. Laparoscopic exploration allows direct visualization of the peritoneum and small bowel, supplementing the imaging findings.