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

  • Regional Cancer Therapies
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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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Conflict of interest

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Surgical Oncology Service in the Department of General Surgery, Wake Forest University, Winston-Salem, NC, USA

    Reese W. Randle MD, Douglas S. Swords BA, Perry Shen MD, FACS, John H. Stewart MD, FACS, Edward A. Levine MD, FACS & Konstantinos I. Votanopoulos MD, PhD, FACS

  2. Department of Biostatistics, Wake Forest University, Winston-Salem, NC, USA

    Katrina R. Swett MS

Authors
  1. Reese W. Randle MD
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  2. Katrina R. Swett MS
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  3. Douglas S. Swords BA
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  4. Perry Shen MD, FACS
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  5. John H. Stewart MD, FACS
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  6. Edward A. Levine MD, FACS
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  7. Konstantinos I. Votanopoulos MD, PhD, FACS
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Corresponding author

Correspondence to Konstantinos I. Votanopoulos MD, PhD, FACS.

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Randle, R.W., Swett, K.R., Swords, D.S. et al. Efficacy of Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy in the Management of Malignant Ascites. Ann Surg Oncol 21, 1474–1479 (2014). https://doi.org/10.1245/s10434-013-3224-y

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  • DOI: https://doi.org/10.1245/s10434-013-3224-y

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