title: Efficacy of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy in the management of malignant ascites.
abstract: BACKGROUND
  In peritoneal surface disease, accumulation of malignant ascites represents a difficult problem to treat, with adverse impact on quality of life. The role of cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) in controlling malignant ascites is not well defined.
  
  
  METHODS
  A retrospective analysis of a prospectively maintained database of 1,000 procedures was performed. Type of malignancy, resolution of ascites, duration and agent of chemoperfusion, performance status, resection status, morbidity, mortality, and survival were reviewed.
  
  
  RESULTS
  Ascites was found in 299 patients (310 procedures) either before or during exploration. A total of 142 (46 %) procedures were performed for appendiceal primary disease, 53 (17 %) colorectal, 20 (6 %) gastric, 45 (15 %) mesothelioma, and 26 (8 %) ovarian. A total of 288 (93 %) patients had resolution of ascites by 3 months' follow-up. In patients with ascites, complete cytoreduction was obtained in 15 versus 59 % when ascites was not present (p < 0.001). In the group of patients who had their ascites controlled, 243 of 288 (84 %) had resection with residual macroscopic disease (R2 status). Twenty-two patients (7 %) had persistent ascites at 3 months' follow-up, 19 (86 %) of whom had an R2 resection. Univariate analysis revealed that type of primary disease, resection status, duration or agent of chemoperfusion, and performance status did not predict failure.
  
  
  CONCLUSIONS
  CRS-HIPEC is effective in controlling ascites in 93 % of patients with malignant ascites, even when a complete cytoreduction is not feasible. Ascites is predictive of incomplete cytoreduction and worse overall survival. Although complete cytoreduction remains the goal of this procedure, HIPEC can provide palliative value in selected patients with malignant ascites.
authors: Surgical Oncology Service in the Department of General Surgery, Wake Forest University, Winston-Salem, NC, USA.
authors: Reese W
authors: RW
authors: Randle
authors: Katrina R
authors: KR
authors: Swett
authors: Douglas S
authors: DS
authors: Swords
authors: Perry
authors: P
authors: Shen
authors: John H
authors: JH
authors: Stewart
authors: Edward A
authors: EA
authors: Levine
authors: Konstantinos I
authors: KI
authors: Votanopoulos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001201:Ascites / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D010478:Chemotherapy, Cancer, Regional Perfusion; D002648:Child; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006979:Hyperthermia, Induced; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009369:Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D010534:Peritoneal Neoplasms / Q000150:complications / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult
references: Eur J Surg Oncol. 2008 Feb;34(2):154-8
references: 17640844
references: Health Technol Assess. 2008 May;12(15):iii-ix, xi-162
references: 18462574
references: World J Gastrointest Surg. 2012 Apr 27;4(4):87-95
references: 22590662
references: J Clin Oncol. 2012 Jul 10;30(20):2449-56
references: 22614976
references: Ann Surg Oncol. 2010 Feb;17(2):461-9
references: 19866240
references: Ann Surg. 1986 Jun;203(6):644-51
references: 3718029
references: World J Gastroenterol. 2010 Apr 21;16(15):1901-7
references: 20397270
references: Ann Surg. 2004 Aug;240(2):205-13
references: 15273542
references: Cancer Treat Res. 1996;82:359-74
references: 8849962
references: J Surg Oncol. 2009 Sep 15;100(4):331-4
references: 19697441
references: Ann Surg Oncol. 2013 Jan;20(1):226-32
references: 22868919
references: Ann Surg Oncol. 2007 Mar;14(3):1105-13
references: 17206478
references: G Chir. 2009 May;30(5):237-9
references: 19505418
references: J Am Coll Surg. 2007 May;204(5):943-53; discussion 953-5
references: 17481516
references: Ann Surg Oncol. 2011 Dec;18(13):3673-9
references: 21674272
references: Case Rep Gastroenterol. 2012 Jan;6(1):166-70
references: 22679405
references: Med Oncol Tumor Pharmacother. 1992;9(4):177-81
references: 1342062
references: World J Surg. 1991 Jul-Aug;15(4):530-5; discussion 535-6
references: 1891941
references: Cancer. 1989 Jan 15;63(2):364-7
references: 2910444
references: Eur J Surg Oncol. 2006 Aug;32(6):682-5
references: 16631341
references: J Am Coll Surg. 2004 Jun;198(6):999-1011
references: 15194082
references: J Am Coll Surg. 2001 Aug;193(2):225-9
references: 11491455
references: Jpn J Clin Oncol. 2007 Dec;37(12):930-5
references: 18211984
references: Am Surg. 1997 Feb;63(2):137-43
references: 9012427