M.Valle 1

K. Van der Speeten 2

A. Garofalo 1

Laparoscopic HIPEC

in

the palliation of

refractory malignant ascites

1 Department of Surgical Oncology, National Cancer Center “Regina Elena”, Rome, Italy 2 Department of Surgical Oncology, Ziekenhuis Oost-Limburg, Genk, Belgium

Malignant ascites : the problem

Abnormal accumulation of fluid in the peritonealcavity as a consequence of malignancy

Median survival : 1-3 months

Significantly decreases QoL : pain, anorexia,dyspnoea…

Conventional treatment unsatisfactory

• Diuretics• Paracentesis• Radio-isotopes• Peritoneo-venous shunts

Malignant ascites : pathofysiology

Tamsma J: The pathogenesis of malignant ascites.Cancer Treat Res, 2006, 109-18.

EM showing lymphatic stomata beneath the hemidiaphragm

Courtesy : Y. Yonemura

Malignant ascites : pathofysiology

Laparoscopic HIPEC : Materials

• September 2001 to August 2008• 52 patients with refractory malignant ascites• Age 31-79 (median 61)• Male/female ratio 0.78• Primary tumor

Gastric = 15Colon = 11Ovarian = 13Breast = 8Mesothelioma = 4Melanoma = 1

Laparoscopic HIPEC : Methods

Open laparoscopy(Midline ports)Aspiration of ascitesLimited adhesiolysis

Rome Genk

Laparoscopic HIPEC : Methods

Inflow-outflow cathetersTemperature probesPressure probesChemoperitoneum 15 mm HgCisplatin, doxorubicin, melphalan, Mito C

Rome Genk

Laparoscopic HIPEC : Results

• Technical faillure : 0

• Complications : 2 minor wound infections, 1 DVT

• Hospital mortality : 0

• Mean hospital stay : 2.3 days (range 1-9)

• Ascites resolved at 1 month (Ultrasound/CT): 49/52

• No readmissions for ascites (*1)

• Median survival : 98 days ( range 21-796)

• Longest survivals in patients with breastca ( 796, 725,455,212 )

Laparoscopic HIPEC : Results

Performance status (QoL) before and after treatment

Laparoscopic HIPEC : Discussion

Laparoscopic HIPEC : Discussion

Laparoscopic HIPEC : Discussion

Laparoscopic HIPEC : Discussion

Laparoscopic HIPEC : Conclusions

• Malignant ascites is a debilitating condition with low QoL

• No efficient conventional therapies

• Laparscopic HIPEC is a safe and feasible procedure

• Pharmacokinetic rationale

• Ascites resolved in 49-52 patients

• No readmissions for ascites