On the Treatment and Prognosis of Malignant Ascites: Is the Survival Time Determined When the Abdominal Paracentesis is Needed

Abstract

We review a series of 100 consecutive cases of malignancy treated for ascites with abdominal paracentesis. The results of treatment for ascites with intracavitary Thiotepa are reported for 23 patients. The temporary partial response rate was 8/23 (35%) patients. There were symptoms of intestinal obstruction in five patients (22%) treated with Thiotepa, and one of these patients died of intestinal obstruction. In 60% of autopsied patients there were abundant intestinal adhesions in the peritoneal cavity after Thiotepa. We concluded that Thiotepa is contraindicated for instillation into the peritoneal cavity. The median survival time for patients with carcinoma of the mammary gland was 47 days, carcinoma of the ovary 121 days, and carcinoma of the large intestine 54 days after the first abdominal paracentesis. We found that patients without clinical liver metastasis at the time of first abdominal paracentesis had almost three times longer median survival time than that of patients with metastatic liver. In four cases the immediate cause of death was a complication of an abdominal paracentesis.

Predictors of Poor Prognosis in Patients with Malignant Ascites: A Prospective Study

“…Ovarian cancer is usually amenable to debulking surgery and has a good response to chemotherapy. Our finding that ascites of ovarian origin has a better median survival than all other cancer groups agrees with previous studies [4][5][6][7][8]. This also may have been responsible for the better survival seen in women compared to men.…”

“…This finding was similar to that from previous studies [4][5][6]8]. Patients with gastrointestinal cancer were found to be more likely to have liver metastases and accounted for 78% of cases with hepatic metastases.…”

“…We have prospectively evaluated various factors that affect survival in patients with malignant ascites and our findings apart from factors identified by previous studies [4][5][6][7][8] has shown the significant role of performance status and other biochemical parameters. Patients with gastrointestinal cancer particularly have a very poor survival compared with the ovarian cancer group.…”

“…However, with better understanding of the pathophysiology of malignant ascites, better diagnostic evaluation and the use of multimodality therapy, it is anticipated that the QoL and survival of these patients may be improved. There are few studies evaluating the natural history of malignant ascites and the prognostic factors relating to survival but they are largely retrospective [4][5][6][7][8].…”

“…It is envisaged that QoL and possibly the survival of patients with malignant ascites may be improved with increasing availability and use of appropriate multimodality therapy including potent combination chemotherapy. Only few studies have reported some factors affecting survival in patients with malignant ascites and are largely retrospective [4][5][6][7][8]. There is therefore need for a prospective study to evaluate the predictors of poor prognosis and survival in patients with malignant ascites.…”