Technical aspects and morbidity assessment of intraperitoneal chemotherapy administered by repeated paracentesis

Adjuvant intraperitoneal chemotherapy was used in an attempt to consolidate effects of previous treatments. Three cycles of adjuvant intraperitoneal chemotherapy by repeated paracentesis were used. On the 3rd day of each cycle mitomycin C was delivered as a 2-h intravenous infusion. 5-Fluorouracil was delivered for 5 consecutive days intraperitoneally by a percutaneous approach. Catheters for intraperitoneal chemotherapy were placed through the abdominal wall by the interventional radiologist on the 1st day of drug instillation. Uniform distribution was assessed by computerized tomography with intraperitoneal contrast. Altogether 23 patients with peritoneal carcinomatosis received 63 of 69 possible cycles. Uniform drug distribution was observed in 63 of 69 (91.3%) cycles. Complications were as follows: intra-abdominal abscess 1 (1.5%) colonic perforation 2 (3.1%), failure to obtain peritoneal access 2 (3.1%), bone marrow toxicity grade III 2 (3.1%), severe pain limiting instillation 2 (3.1%), reoperations for adhesions 0%, ileus 0%. No operations for catheter insertion or catheter removal were ired. There has been no mortality related to adjuvant intraperitoneal chemotherapy. We suggest that intraperitoneal chemotherapy given by repeated paracentesis has acceptable morbidity and may be preferable in terms of quality of life over techniques requiring long-term indwelling peritoneal access devices.