[Peritoneovenous Shunting as a Palliative Therapy for Refractory Ascites after Biliary Cancer Surgery]

The quality of life of patients with recurrence of biliary cancer is remarkably diminished by the occurrence of refractory ascites caused by peritoneal dissemination or portal vein obstruction. In this study, we examined the effectiveness of peritoneovenous shunting (PVS) in patients with refractory ascites after recurrence of biliary cancer. PVS was performed 7 times in 5 patients, with 6 shunts (85.7%) placed from the left-side abdomen to the left subclavian vein. During the median observation period of 136 days, the ascites and symptoms of abdominal distension disappeared in 4 patients. Severe complications consisting of shunt obstruction in 2 patients and post-shunt coagulopathy in 1 patient were also observed. PVS is a useful palliative therapy for refractory ascites in patients with recurrence of biliary cancer. In patients after cancer resection, an appropriate choice of a safe placement route is critical for avoiding abdominal organ injury. The feasibility of PVS in patients with refractory ascites should be considered carefully and in context of their prognosis and performance status because severe complications may occur after this procedure.