Malignant ascites. A comparison of peritoneovenous shunting and nonoperative management

Gough, Ian; Balderson, Glenda A.

doi:10.1002/1097-0142(19930401)71:7<2377::aid-cncr2820710732>3.0.co;2-h

Cited by 65 publications

(30 citation statements)

References 16 publications

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“…Fluid is maintained within the body, minimizing protein and electrolyte loss, and reducing patient discomfort associated with repeated PC 35. This technique permits home management, but requires careful patient selection and post- procedure management to avoid serious complications from fluid overload 6,36. The most common cause of catheter dysfunction was fibrin sheath formation at the venous limb in a significant number of patients.…”

Section: Resultsmentioning

confidence: 99%

“…The most common cause of catheter dysfunction was fibrin sheath formation at the venous limb in a significant number of patients. Successful revision of the shunt could be achieved in the majority 6,37. Another reported complication after PVS insertion was pneumothorax, which occurred more commonly with subclavian puncture compared with other sites of venous access 37,38…”

Section: Resultsmentioning

confidence: 99%

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Drainage of malignant ascites: patient selection and perspectives

Stukan¹

2017

CMAR

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Malignant ascites (MA) is a sign of advanced cancer and poor prognosis. MA can result in impairment in quality of life (QOL) and significant symptoms. As a supportive treatment, ascites can be drained by paracentesis (PC), percutaneously implanted catheters (tunneled, untunneled, central venous catheters), or peritoneal ports, or peritoneovenous shunts. The aim of this study was to evaluate the effectiveness, safety, and patient-reported outcomes (PRO) of different drainage methods for the management of MA. A systematic review of the literature was performed, and 32 original articles met the inclusion criteria. Patients selected for permanent drain insertion demonstrated symptoms related to MA and had undergone repeated PC. The primary focus of the reviewed articles was procedural safety issues. The rate of technical success of drainage device installation was 100%. Most patients experienced improvements in symptom control after ascites drainage. When analyzed together, 19.7% (255/1297) of patients experienced any complication and 6.2% (81/1297) experienced serious adverse events during MA drainage. Complications were reported for every drainage method; however, the least occurred after PC or central venous catheter, while the most serious occurred after peritoneovenous shunts. Adverse events were as follows: catheter obstruction: 4.4%, infection: 4.1%, leakage: 3.5%, catheter dislodgment: 2.3%, hypotension: 0.6%, injuries during device insertion: 0.6%, renal impairment: 0.5%, electrolyte imbalance: 0.2%, other: 3.6%. PRO and QOL endpoints were available for 12 studies. When PRO were measured using an interview, a significant improvement in symptom control and QOL was reported in almost all patients. Once standardized questionnaires were used, improvements in symptomatic scores and role functioning were observed. Deterioration was observed in cognitive and emotional subscales. MA drainage is a safe and effective method to control symptoms associated with ascites, and should be perceived as a supportive care, that can be applied for those who need it at any time of their cancer trajectory. Patient selection should be performed using a thorough assessment of symptoms and QOL, and should not be delayed.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Drainage of malignant ascites: patient selection and perspectives

Stukan¹

2017

CMAR

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“…Although most authors agree that effective palliation can be achieved in a majority of patients who are shunted, 3,9,10,12,15,18,19,21,22,25 Schumacher's 11 relatively recent large study of 89 patients reported no difference in quality of life for the patients receiving shunts compared with those treated by paracentesis. This controversy revolves around the difficulty of choosing which patients will benefit and the difficulty in achieving a high rate of palliation with a low morbidity and mortality rate.…”

Section: Discussionmentioning

confidence: 99%

“…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).…”

Section: Discussionmentioning

confidence: 99%

Peritoneovenous shunting for nongynecologic malignant ascites

Bieligk

Calvo

Coit

2001

Cancer

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“…Common treatment options are repeated paracentesis, external drainage, intraperitoneal chemotherapy, systemic chemotherapy or immunotherapy. Other strategies are peritoneo-venous shunting or intraperitoneal hyperthermic chemotherapy [3][4][5]. At our institution the results for external drainage or intraperitoneal chemotherapy were inadequate.…”

Section: Introductionmentioning

confidence: 99%

Surgical treatment of disseminated peritoneal metastases from urological cancer: results from a prospective study

Otto

Suhr²,

Krege

et al. 2002

BJU International

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Objective To report a prospective phase II study of patients with disseminated peritoneal carcinomatosis and symptomatic disease, in whom the peritoneal metastases were resected. Patients and methods From 1995From to 1999 (20 men and 12 women, median age 56 years, range 32-75) with peritoneal carcinomatosis were enrolled in the trial. Pain and ascites were determined according to the National Cancer Institute score/criteria, and performance scored according to the World Health Organisation criteria. Results All patients had intraperitoneal disseminated malignancies with clinically evident ascites, and presented with abdominal pain. The median (range) operative duration was 2.9 (1-5.5) h and the hospital stay 25 (10-44) days, with no deaths at 30 days. The ascites was completely cured in 25 of the 32 patients, pain relieved in 28 and the performance score improved in 25. The median survival time was 1 year; the 1-and 2-year survival rates were 45% and 38%, respectively. Patients with residual metastases after incomplete resection had a significantly worse prognosis, but the prognosis was significantly better in those with a low tumour burden. Conclusions Peritoneal carcinomatosis is treatable; radical peritonectomy improves the performance score in selected patients with cancer-related ascites and/or pain, and is now the standard approach in the authors' Cancer Centre.

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Malignant ascites. A comparison of peritoneovenous shunting and nonoperative management

Cited by 65 publications

References 16 publications

Drainage of malignant ascites: patient selection and perspectives

Drainage of malignant ascites: patient selection and perspectives

Peritoneovenous shunting for nongynecologic malignant ascites

Surgical treatment of disseminated peritoneal metastases from urological cancer: results from a prospective study

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