Therapeutic results of Denver percutaneous peritoneovenous shunt in cancer patients with malignant ascites

Aoyama, Toru; Inoue, Hirohide; Fujikawa, Hirohito; Sawazaki, Sho; Numata, Masakatsu; Sato, Tsutomu; Oshima, Takashi; Yukawa, Norio; Morimoto, Manabu; Ueno, Makoto; Rino, Yasushi; Masuda, Munetaka

doi:10.4103/jcrt.jcrt_606_18

Cited by 11 publications

(5 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Alternatively, a percutaneous peritoneovenous (Denver) shunt has been reported for the treatment of recurrent malignant ascites. However, most case studies and small retrospective trials reported a relatively high complication rate of up to 40% including severe disseminated intravascular coagulation (DIC), volume overload, shunt occlusion and potential hematologic dissemination [2,15,16]. Even though a direct randomized comparison would be required to draw final conclusions, our current data suggest that implantation of a tunnelled PleurX peritoneal catheter is superior and less invasive than Denver shunts in severely ill cancer patients.…”

Section: Discussionmentioning

confidence: 75%

Tunnelled Peritoneal Catheter for Malignant Ascites—An Open-Label, Prospective, Observational Trial

Petzold¹,

Bremer²,

Heuschert³

et al. 2021

Cancers

View full text Add to dashboard Cite

Treatment of recurrent malignant ascites in cancer patients is a challenge. Evidence based guidelines regarding the best treatment strategy are lacking. The aim of this prospective study was to investigate the safety and efficacy of a tunnelled peritoneal catheter (PleurX) in cancer patients with symptomatic ascites. Patients with symptomatic, diuretics-refractory ascites and indication for the implantation of a tunnelled peritoneal PleurX catheter were prospectively enrolled between August 2018 and July 2020. The number of catheter days, complications, amount of drained ascites and ascites-associated symptoms and hospitalization rate pre- and post-PleurX insertion were analysed. 51 Patients (64.7% male) were prospectively enrolled. The mean age was 66.6 (±7.9) years. The most common cause of ascites was pancreatic adenocarcinoma (n = 10) followed by cholangiocellular carcinoma (n = 9) and hepatocellular carcinoma (n = 8). The technical success rate of PleurX implantation was 100%. The mean volume of weakly drained ascites was 5.44l (±4.08). Major complications included cellulitis (n = 2), peritonitis and drainage dislocation (each n = 1). The mean catheter days per patient was 59.8 (±107.4) (Min 4, Max 668). Abdominal discomfort, impaired mobility, dyspnoea, fatigue, nausea and vomiting were significantly reduced 30 days after PleurX insertion (p < 0.05). Moreover, hospitalization rate was significantly reduced (p < 0.001; 27.08% of days preimplantation vs. 11.27% postimplantation). We conclude that implantation of a tunnelled ascites catheter is a safe and effective method for the treatment of refractory ascites in cancer patients with advanced disease. Serious complications are rare. Burdensome ascites-associated symptoms and hospitalization rates can be significantly reduced over a longer period of time.

show abstract

Section: Discussionmentioning

confidence: 75%

Tunnelled Peritoneal Catheter for Malignant Ascites—An Open-Label, Prospective, Observational Trial

Petzold¹,

Bremer²,

Heuschert³

et al. 2021

Cancers

View full text Add to dashboard Cite

show abstract

“…PVS is generally used as a palliative treatment for patients with severe liver cirrhosis and advanced malignant tumours with relatively short life expectancy. Therefore, the long-term outcomes of this modality remain unclear [ 18 , 19 ]. Consequently, indication of PVS for cases with expected long-term prognosis should be carefully discussed.…”

Section: Discussionmentioning

confidence: 99%

Postoperative chylous ascites after total gastrectomy successfully treated using peritoneovenous (Denver) shunt: a case report

Sakamoto¹,

Takata²,

Noda³

et al. 2022

surg case rep

View full text Add to dashboard Cite

Background Chylous ascites (CA) is a rare complication of gastrectomy for gastric cancer. While most cases of postoperative CA improve with medication or nutritional support, some are refractory to conservative treatment. A peritoneovenous shunt (PVS) may help patients who are poor candidates for surgery. However, PVS placement for postoperative CA after gastroenterological surgery has been rarely reported. Herein, we present a case of postoperative CA following total gastrectomy with para-aortic lymphadenectomy, treated successfully by PVS placement. Case presentation A 74-year-old man who underwent total gastrectomy with para-aortic lymph node dissection was hospitalised because of insufficient oral intake and dehydration. His abdomen was markedly distended with severe bilateral lower extremity oedema. On admission, abdominal computed tomography (CT) showed a high volume of ascites and no signs of cancer recurrence. Accordingly, postoperative CA resulting from drainage of fluid on paracentesis was diagnosed. Despite nutritional support, diuretics, and octreotide administration, his abdominal distension and nutritional status did not improve. We could not identify the sites of lymphatic leakage in the three intranodal lymphangiographies followed by CT. Although we considered a surgical treatment in our patient, we decided against it. Because we could not identify lymphatic leakage site during lymphangiography, surgical treatment might have a potential failure of detection and closure of leakage site. Furthermore, the patient’s general condition was poor because of malnutrition resulting from the loss of lymphatic fluid. Consequently, we decided to place PVS. After PVS placement, his abdominal distension improved rapidly, and he was discharged without serious complications. Thirteen months after PVS, patient has no relapse of abdominal distention and nutrition status has improved. Conclusion PVS might be a good option to manage refractory postoperative CA, as the leakage point cannot be detected on lymphangiography.

show abstract

“…While ultrasound-guided paracentesis is normally reserved for patients who are toward the end of their lives [64], cuffed tunneled peritoneal catheters can be used for long-term external drainage in patients who have a longer life expectancy. A peritoneal catheter joined to a subcutaneous port or completely implanted peritoneovenous (PVS) shunting (such as the Denver shunt) may be used as an alternate instrument for intermittent aspiration in rare cases [65].…”

Section: Fluid Collectionsmentioning

confidence: 99%

Perspective Chapter: Palliative Surgery in Pediatric Cancer

Inserra¹,

Martucci²

2023

Supportive and Palliative Care and Quality of Life in Oncology

View full text Add to dashboard Cite

Childhood can cer survival rates have lately improved (from 54% in 1980 to an actual 80%), and palliative care has taken on a larger role in the management of oncological kids, with many clinicians involved (including oncologists, radiologists, and surgeons). Palliative surgery has evolved from “noncurative” treatments to a variety of surgeries used to relieve organ dysfunction and provide the best possible quality of life in all aspects of life (clinical, psychological, and social).

show abstract

Therapeutic results of Denver percutaneous peritoneovenous shunt in cancer patients with malignant ascites

Cited by 11 publications

References 0 publications

Tunnelled Peritoneal Catheter for Malignant Ascites—An Open-Label, Prospective, Observational Trial

Tunnelled Peritoneal Catheter for Malignant Ascites—An Open-Label, Prospective, Observational Trial

Postoperative chylous ascites after total gastrectomy successfully treated using peritoneovenous (Denver) shunt: a case report

Perspective Chapter: Palliative Surgery in Pediatric Cancer

Contact Info

Product

Resources

About