Laparoscopic evacuation of mucinous ascites for palliation of pseudomyxoma peritonei.
BACKGROUND
Accumulation of mucinous ascites causes significant morbidity for patients with unresectable pseudomyxoma peritonei (PMP). The success of paracentesis for mucin evacuation is limited due to the presence of adhesions, disease burden, and the viscous nature of mucinous ascites. We sought to review our experience with laparoscopic evacuation of mucinous ascites for palliation of PMP.


METHODS
Records were reviewed for patients who underwent laparoscopy for carcinomatosis secondary to appendix or colon cancer from July 2007 to January 2014. Of 123 patients, 10 were identified who underwent 17 laparoscopic procedures for palliative evacuation of mucinous ascites.


RESULTS
All patients had primary appendiceal cancers and all presented with symptomatic ascites causing abdominal distension and bloating. Pneumoperitoneum was established with a Veress needle or 5-mm optical viewing trocar in the majority of cases (n = 11). In the remaining six cases, an open technique was used and a 10-mm Hasson trocar was placed. There were no trocar-related complications. The median volume of mucin evacuated was 2.0 liters (range 1.7-8.0). All procedures were done as same-day surgeries; no patients required hospitalization. All patients reported symptomatic improvement following the procedure. One patient experienced a grade 1 complication of persistent drainage from one incision, which was managed in the outpatient setting. The median follow-up for all pts was 9.1 months. The median time to recurrent symptoms requiring repeat intervention was 5.3 months.


CONCLUSIONS
Laparoscopic evacuation of mucinous ascites for select patients with PMP is feasible and results in significant, durable symptom control with minimal morbidity.
Division of Surgical Oncology, Department of Surgery, University of California San Diego Moores Cancer Center, 3855 Health Sciences Drive #0987, La Jolla, CA, 92093, USA.
Kaitlyn J
KJ
Kelly
Joel M
JM
Baumgartner
Andrew M
AM
Lowy
D002288:Adenocarcinoma, Mucinous / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D001063:Appendiceal Neoplasms / Q000473:pathology / Q000601:surgery; D001201:Ascites / Q000473:pathology / Q000601:surgery*; D003110:Colonic Neoplasms / Q000473:pathology / Q000601:surgery; D004322:Drainage / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009077:Mucins / Q000378:metabolism*; D060787:Neoplasm Grading; D010166:Palliative Care; D010534:Peritoneal Neoplasms / Q000473:pathology / Q000601:surgery*; D011027:Pneumoperitoneum; D011379:Prognosis; D011553:Pseudomyxoma Peritonei / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies
D009077:Mucins