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Laparoscopic evacuation of mucinous ascites for palliation of pseudomyxoma peritonei
Kaitlyn J Kelly1, Joel M Baumgartner, Andrew M Lowy
1Division of Surgical Oncology, Department of Surgery, University of California San Diego Moores Cancer Center, 3855 Health Sciences Drive #0987, La Jolla, CA, 92093, USA.
Introduction:
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.
Insights
Laparoscopic surgery effectively removes mucinous ascites in pseudomyxoma peritonei (PMP) patients, offering significant symptom relief. This minimally invasive approach provides durable palliation with low complication rates.
Area of Science:
- Surgical Oncology
- Gastroenterology
- Minimally Invasive Surgery
Background:
- Mucinous ascites accumulation in unresectable pseudomyxoma peritonei (PMP) causes significant patient morbidity.
- Traditional paracentesis is limited by adhesions, disease burden, and ascites viscosity.
- Laparoscopic evacuation offers a potential palliative solution for PMP-related mucinous ascites.
Purpose of the Study:
- To review the experience with laparoscopic evacuation of mucinous ascites for PMP palliation.
- To assess the feasibility, safety, and efficacy of this minimally invasive approach.
Main Methods:
- Retrospective review of patients undergoing laparoscopy for carcinomatosis (July 2007-January 2014).
- Identified 10 patients who underwent 17 laparoscopic procedures for palliative mucinous ascites evacuation.
- Detailed analysis of surgical techniques, complications, outcomes, and follow-up data.
Main Results:
- All 10 patients had primary appendiceal cancers and symptomatic ascites.
- Median mucin volume evacuated was 2.0 liters; all procedures were same-day surgeries with no hospitalizations.
- All patients reported symptomatic improvement; median follow-up was 9.1 months with a median of 5.3 months to symptom recurrence requiring repeat intervention.
Conclusions:
- Laparoscopic evacuation of mucinous ascites is a feasible option for select PMP patients.
- The procedure provides significant and durable symptom control.
- Minimal morbidity is associated with this minimally invasive palliative intervention.
