title: Determination of the necessary total protein substitution requirements in patients with advanced stage ovarian cancer and ascites, undergoing debulking surgery. Correlation with plasma proteins.
abstract: 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.
authors.affiliation: Department of Gynecology, Metaxa Memorial Cancer Hospital, Piraeus, Greece. vorgiasgeorge@yahoo.gr
authors.forename: George
authors.initials: G
authors.lastname: Vorgias
authors.forename: Christos
authors.initials: C
authors.lastname: Iavazzo
authors.forename: John
authors.initials: J
authors.lastname: Mavromatis
authors.forename: Joanna
authors.initials: J
authors.lastname: Leontara
authors.forename: Michael
authors.initials: M
authors.lastname: Katsoulis
authors.forename: Nickolas
authors.initials: N
authors.lastname: Kalinoglou
authors.forename: Thrassivoulos
authors.initials: T
authors.lastname: Akrivos
mesh_terms: 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
chemical_list: D000418:Albumins; D001798:Blood Proteins