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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 5/2014

01-05-2014 | Regional Cancer Therapies

Efficacy of Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy in the Management of Malignant Ascites

Authors: Reese W. Randle, MD, Katrina R. Swett, MS, Douglas S. Swords, BA, Perry Shen, MD, FACS, John H. Stewart, MD, FACS, Edward A. Levine, MD, FACS, Konstantinos I. Votanopoulos, MD, PhD, FACS

Published in: Annals of Surgical Oncology | Issue 5/2014

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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.
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Metadata
Title
Efficacy of Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy in the Management of Malignant Ascites
Authors
Reese W. Randle, MD
Katrina R. Swett, MS
Douglas S. Swords, BA
Perry Shen, MD, FACS
John H. Stewart, MD, FACS
Edward A. Levine, MD, FACS
Konstantinos I. Votanopoulos, MD, PhD, FACS
Publication date
01-05-2014
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 5/2014
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-013-3224-y

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