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
SPRATT JS. Treatment of Peritoneal Mesothelioma. Arch Surg. 1989;124(2):256. doi:10.1001/archsurg.1989.01410020130023