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Laparoscopic intraperitoneal hyperthermic chemotherapy for palliation of debilitating malignant ascites
A Garofalo1, M Valle, J Garcia
1General-Oncological Surgery, Department of Surgery, S. Camillo Hospital, Rome, Italy.
Summary
Laparoscopic Intraperitoneal Hyperthermic Chemotherapy (LIPHC) effectively controlled malignant ascites in 14 patients with peritoneal carcinomatosis. This minimally invasive treatment offers a beneficial option for patients ineligible for cytoreductive surgery.
Area of Science:
- Oncology
- Surgical Oncology
- Minimally Invasive Surgery
Background:
- Malignant ascites is a common complication of advanced cancers, significantly impacting patient quality of life.
- Cytoreductive surgery is often not feasible for patients with extensive peritoneal carcinomatosis.
Purpose of the Study:
- To evaluate the efficacy and safety of Laparoscopic Intraperitoneal Hyperthermic Chemotherapy (LIPHC) for managing malignant ascites.
- To assess LIPHC as a treatment option for patients with peritoneal carcinomatosis excluded from cytoreductive surgery.
Main Methods:
- 14 patients (56-78 years) with ascites from various cancers (gastric, colorectal, ovarian, breast, mesothelioma) underwent LIPHC.
- LIPHC involved a 90-minute infusion at 42°C using a dextrose carrier with chemotherapy (cisplatin, doxorubicin, or mitomycin).
- Surgical drains were used post-procedure and removed upon cessation of drainage.
Main Results:
- Complete control of malignant ascites was achieved in all 14 treated patients.
- Follow-up CT scans revealed only a small, clinically insignificant fluid collection in one patient's pelvis.
- The procedure demonstrated a high rate of ascites control with minimal residual fluid accumulation.
Conclusions:
- LIPHC provides significant benefit for patients with debilitating malignant ascites due to peritoneal carcinomatosis, especially when cytoreductive surgery is not an option.
- Successful LIPHC requires proficiency in laparoscopic techniques, carcinomatosis management, and intraperitoneal hyperthermic chemotherapy (IPHC).
- This approach represents a valuable therapeutic strategy for selected oncology patients with refractory malignant ascites.
