Pancreas Adenocarcinoma: Ascites, Clinical Manifestations, and Management Implications

Abstract

This was a cohort analysis evaluating patients with pancreatic adenocarcinoma who presented with or developed ascites. Among the 180 patients analyzed, the use of serial paracenteses and indwelling catheters is a common practice to effect symptom palliation. The complication rate was higher in patients with indwelling catheters. Analyzing ascitic fluid and calculating the serum ascites albumin gradient can help attribute the etiology of the ascites and potentially identify which patients may benefit from diuretics or other intervention. Background Ascites develops in a subset of patients with pancreatic adenocarcinoma (PAC) at presentation or as the disease advances. Limited data exist on the prognostic importance of malignant ascites in PAC. Our hypothesis is that this information will provide an understanding of the natural history and facilitate management decisions. Methods We conducted a retrospective analysis of 180 patients treated at Memorial Sloan Kettering Cancer Center diagnosed between January 1, 2009 and December 31, 2014, with PAC and with ascites either at presentation or that developed during the disease course. Results For the 180 patients, the overall survival was 15 months. The time from diagnosis to ascites presentation was 11 months, and the survival time after ascites development was 1.8 months (range, 1.6–2.3 months; 95% confidence interval). Of 62 patients (34%) who had ascitic fluid analyzed, 36 (58%) had positive cytology. Fifty-one (82%) patients had a serum ascites albumin gradient ≥ 1, and 11 (18%) had serum ascites albumin gradient < 1. Sixty-four (36%) patients had their ascites managed solely by serial paracenteses. A total of 116 patients required a catheter; of these, 108 (93%) had a Tenckhoff catheter, 4 (3%) a Pleurx catheter, 4 (3%) a pigtail catheter, and 1 (1%) a Denver catheter. Eight (7%) patients required 2 catheters to be placed, and in 6 (5%), Tenckhoff catheters had to be removed. The main observed complications were spontaneous bacterial peritonitis in 7 (11%) managed with paracenteses versus 26 (23%) who had a catheter placed, catheter malfunction in 8 (7%), and acute renal failure in 6 (3%). After ascites development, 79 (44%) patients received active anti-cancer therapy, and 101 (56%) patients were managed with supportive care alone. Conclusions In patients with PAC who presented with or developed ascites, serial paracenteses and indwelling catheters are common methods used for providing symptomatic relief. The complication rate was higher with indwelling catheters, primarily related to infection (eg, bacterial peritonitis). Overall, ascites has a significantly negative prognostic import with a short median survival.

Tumor-promoting effects of pancreatic cancer cell exosomes on THP-1-derived macrophages

“…In fact, exosomes from the normal pancreatic cell line HPDE H6c7 were surprisingly similar in many respects to exosomes from primary pancreatic tumor cell lines. Clinically, ascites are present in approximately one-third of PDAC patients and the presence of ascites is associated with peritoneal spread, significantly worse prognosis and shortened median survival [ 32 ]. The presence of tumor cells in ascites fluid is well documented, and has been used to individualize patient treatment [ 33 ].…”

A Tumor-targeting Adenovirus with High Gene-transduction Efficiency for Primary Pancreatic Cancer and Ascites Cells

“…The direct injection of pancreatic cancertargeting adenovirus vectors including oncolytic viruses is a promising therapeutic strategy for locally advanced pancreatic cancer, in order to control local lesions and to prevent distant metastasis (11,18). In contrast, many patients with advanced-stage disease suffer from the accumulation of ascites via peritoneal dissemination of the primary tumor (8). Treatment with peritoneal tumor-targeting vectors immediately after surgery could delay the occurrence of metastases and prolong patient survival.…”

“…Treatment with peritoneal tumor-targeting vectors immediately after surgery could delay the occurrence of metastases and prolong patient survival. In addition, suppressing peritoneal tumors with targeting vectors should improve patient quality of life (8).…”

“…Ascites develops in 20% of patients with pancreatic cancer, which causes deteriorated quality of life; the duration of survival after ascites development is only a couple of months. Available medical treatments for patients with malignant ascites include the use of diuretics or paracentesis (7,8). A novel approach to treat peritoneal dissemination is thus needed.…”

Apatinib concurrent gemcitabine for controlling malignant ascites in advanced pancreatic cancer patient

“…Malignant ascites (MA) is a common manifestation of advanced pancreatic cancer and presents with a poor prognosis, with a median overall survival (OS) of 1 to 3 months. [ 1 , 2 ] One of the highest priorities is the active management of coeliac effusion for improving the patients’ quality of life. The current mode of therapy for patients with MA primarily depends on local treatment, such as tube drainage, and intrapleural administration of chemotherapeutic agents such as platinum-containing regimen.…”