The role of minimally invasive diagnostic techniques in optimizing treatment strategies in patients with colorectal cancer

Abstract

OBJECTIVE – to improve staging accuracy and optimize therapeutic strategies in patients with colorectal cancer by performing minimally invasive diagnostic procedures, specifically diagnostic laparoscopy with peritoneal lavage and cytological examination, and mediastinoscopy with targeted lymph node biopsy, in cases where conventional imaging methods (computed tomography [CT], magnetic resonance imaging [MRI], positron emission tomography combined with computed tomography [PET-CT]) yield equivocal or inconclusive results. MATERIALS AND METHODS. This ambispective (retrospective–prospective) study was conducted from 2023 to 2025 and included 37 patients with colorectal cancer who had inconclusive standard imaging results regarding distant metastases or peritoneal carcinomatosis. Patients were allocated into two groups: 22 patients with suspected peritoneal carcinomatosis underwent diagnostic laparoscopy with peritoneal lavage, peritoneal biopsy, and cytological analysis, while 15 patients with suspected mediastinal lymph node involvement underwent cervical mediastinoscopy with targeted lymph node biopsy. Diagnostic accuracy, the impact of findings on subsequent therapeutic management, and procedural safety were evaluated. RESULTS. Peritoneal carcinomatosis was morphologically confirmed in 19 of 22 patients (86.4 %), and metastatic involvement of mediastinal lymph nodes was confirmed in 11 of 15 patients (73.3 %). Verification of the pathological process resulted in a change in therapeutic strategy for 29 of 37 patients (78.4 %). Specifically, 27 patients (73.0 %) received systemic chemotherapy, 7 patients (18.9 %) underwent radical surgical procedures, 2 patients (5.4 %) underwent palliative resection, and 1 patient (2.7 %) declined further treatment. No serious intraoperative complications were observed. Minor postoperative events, including pain at the puncture site, subcutaneous emphysema, and transient fever, occurred in 8 patients (21.6 %) and did not require additional treatment. CONCLUSIONS. Incorporating diagnostic laparoscopy and mediastinoscopy into the colorectal cancer staging algorithm yields high diagnostic accuracy, supporting personalized treatment planning. The application of minimally invasive methods reduces unnecessary surgical interventions, shortens the time to initiation of systemic therapy, and may improve prognosis in patients with advanced disease.