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Peritoneal expansion by artificially produced ascites during perfusion chemotherapy
D Tsiftsis1, E de Bree, J Romanos
1Department of Surgical Oncology, Medical School, University of Crete, Herákleion, Greece. tsiftsis@cc.uch.gr
Hypothesis:
In cases of peritoneal carcinomatosis, continuous hyperthermic peritoneal perfusion chemotherapy (CHPPC) accomplishes homogeneous distribution of the drug and heat to the entire peritoneal cavity and exposure of the visceral and parietal surfaces to the perfusate. A new closed technique for expansion that produces artificial ascites is safer for medical personnel because of less heat and drug loss and more efficacious in its hemodynamic effect on the patient.
Design:
Prospective study.
Setting:
University hospital.
Patients:
Twenty-one patients with peritoneal carcinomatosis.
Interventions:
We performed 23 continuous hyperthermic peritoneal perfusion chemotherapy (CHPPC) procedures with peritoneal cavity expansion to an intra-abdominal pressure up to 26 mm Hg, using artificially produced ascites with 4 to 9 L normal saline solution.
Main Outcome Measures:
Intraoperative and postoperative complications and hemodynamic changes during CHPPC.
Results:
No intraoperative complications were recorded. The artificially produced ascites did not cause significant hemodynamic changes. During the immediate postoperative period, 1 patient died of intra-abdominal hemorrhage and leakage of a colorectal anastomosis, resulting in a mortality rate of 4% in our series. Minor complications were seen in 14 patients. The complications were not attributable to the expansion technique.
Conclusions:
Our proposed modification of closed-circuit CHPPC appears to be well tolerated and safe in patients with a high tumor load, as well as for the theater personnel. It remains to be investigated whether the theoretical advantages of the proposed technique will also lead to better long-term results.