Selection of patients with malignant ascites for a peritoneovenous shunt

Abstract

Twenty‐two patients with intractable malignant ascites who received a peritoneovenous shunt were studied. We found that the peritoneovenous shunt functioned longer in patients whose ascitic fluid was negative for malignant cells. The median shunt survival in alive patients in the negative cytologic group was 140 days compared to 26 days in the positive cytologic group (P = 0.01). The overall survival of these patients was poor, with a median of 32 days. Median survival of patients with positive cytologic results (26 days) was significantly worse than for the cytologically negative group (80 days; P = 0.05). The incidence of tumor emboli, confirmed at autopsy, was estimated to be about 5%. Seventy‐five percent of all complications occurred in the group of patients with a positive cytologic result. We conclude that a positive ascites fluid cytologic finding is a relative contraindication to placement of a peritoneovenous shunt since this is associated with early shunt failure, postoperative coagulopathy, infection, and tumor emboli. However, since the serious complication rate is only 4% and tumor emboli rate 5%, peritoneovenous shunting in symptomatic patients with cytologically negative malignant ascites is a useful palliative procedure.

Peritoneovenous shunting for nongynecologic malignant ascites

“…11,25,26 Reductions in platelet count and fibrinogen level and a corresponding increase in the prothrombin time have been reported in other recent series as limited contributors to morbidity and mortality rates. 8,10,11,23,24,27 In the current series, these changes after PVS placement did not demonstrate a statistical association with poorer survival. Unlike others, 26 fibrin split product (FSP) measurement was not performed uniformly in our patients (3 patients had preprocedure FSP values measured; 11 patients had positive postoperative FSP values).…”

“…This is in contrast to an earlier report from Memorial Hospital (New York, NY) suggesting that patients with positive cytology should not be considered as candidates for peritoneovenous shunting. 8 A number of investigators have demonstrated that those patients with peritoneal carcinomatosis, a predictor of poor outcome, are more likely to have positive cytology. 12,15,17 Some have suggested that patients with malignant ascites and negative cytology may have advanced liver disease, which is, in The 51% complication rate seen in the current series is high but is comparable to others.…”

Malignant ascites. A comparison of peritoneovenous shunting and nonoperative management

“…Routine laboratory methods were used for blood coagulation, hematologic studies, and biochemical monitoring. Quality of life was measured by the re- Ovary (11)(12)(13)(14)(15)(16) All Gastrointestinal (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) ..........…”

Ascitic Fluid in Ovarian Carcinoma – From Pathophysiology to the Treatment

“…Other new therapeutic approaches to be pointed out include immunotherapy with interferon, tumor necrosis factor, Corynebacterium parvum, and Streptococcal preparation OK-432 [117].…”