Reappraisal of a Renovated Cell-free and Concentrated Ascites Reinfusion Therapy for Malignant Ascites.

BACKGROUND/AIM: Cell-free and concentrated ascites reinfusion therapy (CART) was established for refractory ascites and renovated CART (Keisuke Matsusaki (KM) -CART) has been recently developed especially for malignant ascites; however, the actual clinical efficacy of KM-CART has been rarely reported. PATIENTS AND METHODS: We performed 226 KM-CART procedures in 104 patients with malignant ascites in three hospitals from August 2013 to September 2018. Medical records were retrospectively reviewed for ascites data, related complications, symptoms before and after each CART and prognosis after the first CART. The modified Glasgow Prognostic Score (mGPS) was reviewed before every procedure, as an indicator of nutritional status. RESULTS: Pancreatic cancer was the most common indication for the KM-CART procedure, followed by gastric cancer, hepatocellular carcinoma, ovarian cancer, and cholangiocarcinoma (five major diseases). The 50% survival times of these five major diseases after the first procedure were 25, 39, 31, 49, and 33 days, respectively. The mean survival time for all patients was 73.5 days, and 75.6 days for those with the five major diseases. All patients experienced symptomatic relief, and complications were rare. Repeated KM-CART was performed in 47.1% of the patients, most often in those with ovarian cancer (66.7%). Regarding the mGPS at the first CART procedure, 89% of patients were in the group with the poorest nutritional status. Patients who underwent KM-CART three or more times had longer survival than those who were treated once or twice. CONCLUSION: Repeated KM-CART provides a survival benefit for patients with malignant ascites, even in cases of poor nutritional status.

Evaluation of tissue blood flow of the gastric tube after vessel anastomosis for esophageal reconstruction.

OBJECTIVES AND METHODS: Impaired blood flow of the upper end of the gastric tube is one of the major causes of anastomotic leak following esophageal reconstruction after esophagectomy for cancer. We applied an additional microvascular anastomosis procedure--the supercharging technique--to improve blood flow. We investigated blood flow improvement in 15 patients who underwent the supercharging technique after total excision of the thoracic esophagus and gastric tube reconstruction through the posterior mediastinal route from August 2003 to March 2005. RESULTS: Tissue blood flow was measured with laser Doppler flowmetry during surgery and was improved after microvascular anastomosis. Patency and blood flow of anastomosed arteries were evaluated with computed tomography and ultrasonography, respectively. Patency and stable blood flow of anastomosed arteries were confirmed more than 1 month after surgery. Therefore, microvascular anastomosis improved the tissue blood flow of the upper end of the gastric tube. Long-term blood flow improvement was confirmed, which suggests that microvascular anastomosis contributes to reducing the risk of anastomotic leak.