Peritoneovenous shunts for palliation of the patient with malignant ascites

This study evaluated the effectiveness and morbidity associated with 116 peritoneovenous shunts inserted into 89 patients for symptomatic malignant ascites between 1981 and 1991. All patients had previously failed standard medical therapy of salt and fluid restriction, diuretics, and intermittent peritoneal aspirations.

Symptoms from the ascites included discomfort, impaired mobility, early satiety, and dyspnea. The study population was composed of 31 men and 58 women whose ages ranged from 24 to 81 years (mean 56). Primary tumors originated from the following sites: breast, 17; ovary, 17; pancreas, 13; gastrointestinal or related organs, 21; and other sites, 21. Mean shunt patency was 83 days; however, only 31% of the patients studied maintained a patent shunt and lived for > 2 months. Symptomatic relief was achieved in only 57 patients (62%). Forty-four patients (49%) developed one or more complications related to shunt placement. The deaths of 12 patients (13%) within 30 days of surgery were directly related to a complication of shunt placement. Overall, 30- and 60-day mortality rates were 43% and 61%, respectively.

Due to the brief and only fair relief of symptoms with a high associated morbidity and mortality, we believe peritoneovenous shunts are of very limited usefulness in the palliation of malignant ascites and suggest that alternate methods should be considered to manage these patients.