Determination of the necessary total protein substitution requirements in patients with advanced stage ovarian cancer and ascites, undergoing debulking surgery. Correlation with plasma proteins.
BACKGROUND
Ascites is common in patients with advanced ovarian carcinoma (AOC). Its drainage during surgery affects plasma proteins. We sought to correlate the volume of ascites with the oncological parameters of the disease, calculate its drainage effect on plasma proteins, and determine the necessary substitution requirements and a clinical way of achieving that.


METHODS
We evaluated 138 patients with AOC and ascites who underwent primary cytoreductive surgery. Intraoperatively found ascites and its postoperative production were evaluated. Its drainage effect on plasma proteins and the substitution requirements were determined using a mathematic formula. Human albumin(HA) and fresh frozen plasma (FFP) were used to cover these requirements.


RESULTS
The intraoperative ascites was found to correlate only with the stage of the disease, while its postoperative production correlated with the residual disease. Optimally debulked patients had a mean ascites production of 128 mL on postoperative day 1 compared with 668 mL of the suboptimally debulked. This production required 3 and 5-7 days, respectively, to drop <50 mL. Plasma proteins fell on their minimum level (88.9 versus 80.8%) on the second postoperative day. The protein deficit was calculated to be 379 and 691 g/day, respectively. This deficit was substituted by administering 2 HA and 2 FFP for 3-6 days.


CONCLUSIONS
Ascites drainage affects the postoperative homeostasis of plasma proteins. A mean acute drop of 12-20% is monitored on postoperative day 2. This deficit can be managed with HA and FFP for a minimum of 3 days.
Vorgias
George
G
Department of Gynecology, Metaxa Memorial Cancer Hospital, Piraeus, Greece. vorgiasgeorge@yahoo.gr
Iavazzo
Christos
C
Mavromatis
John
J
Leontara
Joanna
J
Katsoulis
Michael
M
Kalinoglou
Nickolas
N
Akrivos
Thrassivoulos
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000418:Albumins / Q000627:therapeutic use; D001201:Ascites / Q000378:metabolism; D001202:Ascitic Fluid / Q000737:chemistry / Q000378:metabolism; D001798:Blood Proteins / Q000032:analysis* / Q000627:therapeutic use; D004322:Drainage; D005260:Female; D006706:Homeostasis / Q000502:physiology; D006801:Humans; D007430:Intraoperative Care; D008875:Middle Aged; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D010051:Ovarian Neoplasms / Q000601:surgery*; D010949:Plasma; D013997:Time Factors
D000418:Albumins; D001798:Blood Proteins