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JOHN S. SPRATT, MD
Louisville

Arch Surg. 1989;124(2):256.

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To the Editor.—The discussion of management of peritoneal mesothelioma by Plaus¹ is good but incomplete. The behavior of these neoplasms is highly variable in the degree of aggressiveness and the physician risks adding to morbidity by overtreating. The use of a peritoneovenous shunt is not without risk, and with it or without it other approaches may be useful.

In the presence of malignant ascites, copious irrigation of the peritoneal cavity with 5% dextrose in water (DW) at laparotomy is essential. The mucopolysaccharide responsible for the viscosity of malignant ascites (as with pseudomyxoma peritonei) is miscible in 5% DW. Viable tumor cells persist in a third-space haven when this is not done. Pulmonary capillary occlusion and coagulopathies have been reported with peritoneovenous shunts.

The mesothelium is also particularly sensitive to hyperthermia. (We use 5% DW heated to 50°C for a three-minute wash after the wash with 5% DW at . . . [Full Text PDF of this Article]

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