title: Laparoscopic hyperthermic intraperitoneal chemotherapy (HIPEC) for refractory malignant ascites in patients unsuitable for cytoreductive surgery.
abstract: BACKGROUND
  Malignant ascites (MA) is the abnormal accumulation of fluid in the peritoneal cavity of patients with intraperitoneal dissemination of their disease and is associated with a short life expectancy. The most common clinical feature is a progressive increase of abdominal distention resulting in pain, discomfort, anorexia and dyspnoea. Currently, no treatment is established standard of care due to limited efficacy or considerable toxicity. The objective was to examine the efficacy of laparoscopic hyperthermic intraperitoneal chemotherapy (HIPEC) in the palliation of refractory MA in patients who were unsuitable for cytoreductive surgery.
  
  
  METHODS
  From May 2009 to June 2015, 12 patients with MA due to their peritoneal malignancy were treated with laparoscopic HIPEC. The time between operation and repeat paracentesis, in-hospital data, and the proportion of patients that did not require repeat paracentesis was analyzed.
  
  
  RESULTS
  One patient (8%) was admitted to ICU for 1 day. The mean operating time and hospital stay was 149.3 min (range 79-185) and 4.6 days (range 2-11) respectively. Neither high-grade morbidity nor mortality was observed. The median OS was 57 days. In our experience, a complete and definitive disappearance of MA was observed in 83% of patients. Two patients (17%) developed recurrent MA 124 days and 283 days post-HIPEC.
  
  
  CONCLUSIONS
  Laparoscopic HIPEC is a beneficial treatment for the management and palliation of refractory MA and results in an excellent clinical and radiological resolution in patients with a complete resolution observed in selected patients.
authors.affiliation: University of New South Wales Department of Surgery, St George Hospital, Kogarah, Australia.
authors.forename: S J
authors.initials: SJ
authors.lastname: Valle
authors.affiliation: University of New South Wales Department of Surgery, St George Hospital, Kogarah, Australia; College of Medicine, Al-Iman Muhammad Ibn Saud Islamic University, Riyadh, Saudi Arabia. Electronic address: nayefalhariri@hotmail.com.
authors.forename: N A
authors.initials: NA
authors.lastname: Alzahrani
authors.affiliation: University of New South Wales Department of Surgery, St George Hospital, Kogarah, Australia.
authors.forename: S E
authors.initials: SE
authors.lastname: Alzahrani
authors.affiliation: University of New South Wales Department of Surgery, St George Hospital, Kogarah, Australia; Cancer Care Centre, St George Hospital, Kogarah, Australia.
authors.forename: W
authors.initials: W
authors.lastname: Liauw
authors.affiliation: University of New South Wales Department of Surgery, St George Hospital, Kogarah, Australia.
authors.forename: D L
authors.initials: DL
authors.lastname: Morris
mesh_terms: D000328:Adult; D000368:Aged; D001201:Ascites / Q000150:complications / Q000188:drug therapy*; D003131:Combined Modality Therapy; D065426:Cytoreduction Surgical Procedures; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010529:Peritoneal Cavity / Q000601:surgery; D010534:Peritoneal Neoplasms / Q000150:complications; D012189:Retrospective Studies; D016019:Survival Analysis
keywords: Cytoreductive surgery (CRS); Hyperthermic intraperitoneal chemotherapy (HIPEC); Laparoscopic; Malignant ascites; Palliation; Peritoneal carcinomatosis (PC)