Chemotherapy with laparoscope-assisted continuous circulatory hyperthermic intraperitoneal perfusion for malignant ascites

AIM:To investigate the procedure, feasibility and effects of laparoscopeassisted continuous circulatory hyperthermic intraperitoneal perfusion chemotherapy (CHIPC) in treatment of malignant ascites induced by peritoneal carcinomatosis from gastric cancers. METHODS: From August 2006 to March 2008, the laparoscopic approach was used to perform CHIPC on 16 patients with malignant ascites induced by gastric cancer or postoperative intraperitoneal seeding. Each patient underwent CHIPC three times after laparoscopeassisted perfusion catheters placing. The first session was completed in operative room under general anesthesia, 5% glucose solution was selected as perfusion liquid, and 1500 mg 5 fluorouracil (5FU) and 200 mg oxaliplatin were added in the perfusion solution. The second andthird sessions were performed in intensive care unit, 0.9% sodium chloride solution was selected as perfusion liquid, and 1500 mg 5FU was added in the perfusion solution alone. CHIPC was performed for 90 min at a velocity of 450600 mL/min and an in flow temperature of 43 ± 0.2℃.RESULTS: The intraoperative course was uneventful in all cases, and the mean operative period for laparoscopeassisted perfusion catheters placing was 80 min for each case. No postoperative deaths or complications related to laparoscopeassisted CHIPC occurred in this study. Clinically complete remission of ascites and related symptoms were achieved in 14 patients, and partial remission was achieved in 2 patients. During the followup, 13 patients died 29 mo after CHIPC, with a median survival time of 5 mo. Two patients with partial remission suffered from port site seeding and tumor metastasis,and died 2 and 3 mo after treatment. Three patients who are still alive today survived 4, 6 and 7 mo, respectively. The Karnofsky marks of patients (5090) increased significantly (P < 0.01) and the general status improved after CHIPC. Thus satisfactory clinical efficacy has been achieved in these patients treated by laparoscopic CHIPC. CONCLUSION: Laparoscopeassisted CHIPC is a safe, feasible and effective procedure in the treatment of debilitating malignant ascites induced by unresectable gastric cancers.

Leptin levels in the differential diagnosis between benign and malignant ascites

AIM： To evaluate the role of leptin levels in the differentia diagnosis of ascites. METHODS： Ascitic leptin, TNFα and serum leptin levels were measured in 77 patients with ascites （35 with malignancies, 30 cirrhosis and 12 tuberculosis）. Control serum samples were obtained from 20 healthy subjects. Leptin and TNFα levels were measured by EUSA. Body mass index （BMI） and percentage of body fat （BFM） by skin fold measurement were calculated for all patients and control groups. Peritoneal biopsy, ascites cytology and cultures or biochemical values were used for the diagnosis of patients. RESULTS： In patients with malignancies, the mean serum and ascites leptin levels and their ratios were significantly decreased compared to the other patient groups and controls. In tuberculosis peritonitis, ascitic fluid TNFα levels were significantly higher than malignant ascites and cirrhotic sterile ascites. BMI and BFM values did not distinguish between patients and controls. CONCLUSION： In patients with malignant ascites, levels of leptin and TNFα were significantly lower than in patients with tuberculous ascites.

Primary malignant peritoneal mesothelioma mimicking tuberculous peritonitis:A case report

BACKGROUND Malignant peritoneal mesothelioma(MPM)is a rare malignancy arising in mesothelial cells in the peritoneum.It can be mistaken for many other diseases,such as peritoneal carcinomatosis and tuberculous peritonitis(TBP),because its clinical manifestations are often nonspecific.Therefore,the diagnosis of MPM is often challenging and delayed.CASE SUMMARY A 42-year-old man was referred to our hospital with lower abdominal pain for 1 wk and ascites observed under abdominal sonography.His laboratory findings revealed an isolated elevated tumor marker of carcinoma antigen 125(167.4 U/m L;normal,<35 U/m L),and contrast enhanced computed tomography showed peritoneal thickening.Thus,differential diagnoses of TBP,carcinomatosis of an unknown nature,and primary peritoneal malignancy were considered.After both esophagogastroduodenoscopy and colonoscopy produced negative findings,laparoscopic intervention was performed.The histopathological results revealed mesothelioma invasion into soft tissue composed of a papillary,tubular,single-cell arrangement of epithelioid cells.In addition,immunohistochemical staining was positive for mesothelioma markers and negative for adenocarcinoma markers.Based on the above findings,TBP was excluded,and the patient was diagnosed with MPM.CONCLUSION It is important to distinguish MPM from TBP because they have similar symptoms and blood test findings.

Malignant ascites with omental metastasis: a rare event in prostate cancer

Prostate cancer is the most common type of male malignancy in the world and approximately 10-20%of prostate cancer shows a metastatic disease at initial diagnosis commonly to the bones,vertebrae,ribs,long bones,and skull.However,prostate cancer metastasis to the omentum with malignant ascites is extremely uncommon.In this study,we report such a case,which also highlights a repeatedly negative ascetic fluid cytology even with multiple omental metastatic nodules.The purpose of this case report is to provide awareness to physicians for this rare occurrence.

Tunneled peritoneal catheters for the palliative therapy of malignant ascites

Objective:Malignant ascites presents difficult management issues in the palliative care population and results in distressing symptoms and recurrent hospital admissions.The palliative care services in Our Lady of Lourdes Hospital have been using radiologically guided tunneled peritoneal catheters for the palliative therapy of troublesome malignant ascites.We conducted a review of this management strategy.Methods:There were 10 catheters inserted in 9 patients between May 2007 and June 2011 in patients with malignant ascites.Results:There were no procedural related mortalities or major complications.Mean catheter life was 98.9 days.Post catheter re-hospitalization rate was 1.55 times per patient.Mean patient survival post insertion was 140 days.Eighty eight percent of patients achieved death at home.Conclusion:We conclude that this is a safe and useful strategy in the management of malignant ascites in a palliative care population.