Successful palliation of malignant ascites from peritoneal mesothelioma by laparoscopic intraperitoneal hyperthermic chemotherapy.

Malignant ascites account for around 10% of all cases of ascites and occur in association to a variety of neoplasms including colon, pancreas, breast, stomach, ovary, and mesothelioma. A variety of options have been proposed to treat malignant ascites but most of them have failed to reach a significant impact in terms of palliation. Laparoscopic hyperthermic intraperitoneal chemotherapy (LHIPEC) could represent a good therapeutic tool for patients in whom medical therapies have failed and peritoneovenous shunting is contraindicated. Retrospective studies describing the use of laparoscopic hyperthermic intraperitoneal chemotherapy (LHIPEC) to treat debilitating ascites in patients who were not candidates for cytoreductive surgery or hyperthermic intraperitoneal chemotherapy (HIPEC) reported a success rate of 100%. Although the use of AQ1 LHIPEC in this setting needs further evaluation in prospective trials and standardization of perfusion parameters, this technique could have promising employs in selected patients. Here we present a case of a 49-year-old woman with malignant ascites secondary to peritoneal spreading of a right pleural mesothelioma. After failure of medical therapy, the patient underwent LHIPEC with Cisplatin 25 mg/m2/L and Doxorubicin 7 mg/m2/L. A dramatic reduction of ascites was documented in the postoperative period and the patient experienced complete abdominal symptom relief. Ascites did not recur during a follow-up period of 6 months. LHIPEC could be a good therapeutic option to palliate malignant ascites from mesothelioma in cases not eligible for a radical treatment. Further studies are needed to standardize dosage and perfusion parameters.