The Denver type for peritoneovenous shunting of malignant ascites

Peritoneovenous shunts of the Denver type were inserted into 36 patients to control malignant ascites. The Denver system features a compressible pump chamber bearing a pressure sensitive valve. Initially, all the shunts functioned well. The shunt remained open until death in 21 patients, and at the beginning of the analysis, another two patients were still alive with an open shunt. Blockage of the shunt occurred in 13 patients before death. The cumulative survival time for patients after shunt insertion was 129 months and the cumulative shunt functioning time was 92 months. The over-all median survival time after shunt installation was 13 weeks, and calculated actuarially, the median shunt functioning time for long term survivors was 14 weeks. The cytologic state of the ascitic fluid did not make a statistically significant difference to the blockage-free interval (p = 0.99), neither did the type of primary tumor (p = 0.37). Complications were of a minor type. There was no laboratory or clinical evidence of disseminated intravascular coagulation. Tumor spread through the tubing was seen in one of the three autopsies performed. Denver type peritoneovenous shunting appears to provide effective palliation in the majority of patients. It should, however, only be performed as a last resort.