Treatment of malignant ascites in patients with advanced cancer: peritoneovenous shunt versus paracentesis

Malignant ascites in patients with advanced cancer is often difficult to treat and effective palliation is not achieved.

We performed peritoneovenous shunt (PVS) placement in patients with malignant ascites, who were admitted to our institution between January 2000 and March 2005. The outcome of PVS placement was compared with paracentesis as a treatment option during the same period. Comparisons included changes in abdominal girth, hematocrit (Hct), blood urea nitrogen (BUN) and creatinine (Cr) measurements before and after PVS placement. The number of procedures, changes in the postoperative performance score, the median survival, possibility of discharge, and complications were compared between the two groups.

Twenty patients underwent PVS placement and 49 patients were subjected to paracentesis. After PVS, abdominal girth and Hct decreased significantly. BUN and Cr tended to decrease. The median number of procedures was less in the PVS group than in the paracentesis group (one vs two, respectively; P < 0.0001). The postoperative performance score showed a significant improvement following PVS placement (P = 0.0026). Median survival was significantly longer for patients undergoing PVS placement than for those undergoing paracentesis (42 days vs 18 days, respectively; P = 0.003). The rate of possible discharge was significantly higher for patients undergoing PVS placement (P = 0.0076). Severe complications were observed in one patient in the PVS group and in seven patients in the paracentesis group.

PVS placement provides an effective treatment option for patients with refractory malignant ascites in advanced cancer, and yields a higher likelihood of discharge compared with conventional paracentesis.