-Report on Experiments and Clinical Cases-

Peritoneovenous Shunts for Palliation of Malignant Ascites

Yasuhiro Mamada, Hiroshi Yoshida, Nobuhiko Taniai, Kouichi Bandou, Tetsuya Shimizu, Daisuke Kakinuma, Yoshiaki Mizuguchi, Yoshinori Ishikawa, Koho Akimaru and Takashi Tajiri

Surgery for Organ Function and Biological Regulation, Graduate School of Medicine, Nippon Medical School

Background: Malignant ascites may produce a cluster of symptoms that include abdominal distention, early satiety, respiratory embarrassment, impaired mobility, and lethargy, and relief of these symptoms is often difficult to achieve. We report on the placement of peritoneovenous shunts (PVSs) in a group of patients with malignant ascites, with particular reference to the effectiveness and complications of the procedure.
Patients and Method: PVSs were inserted in 9 patients with malignant ascites after obtaining their informed consent. The patients were 6 men and 3 women with a median age of 59 years. All had previously been treated with vigorous diuretic therapy or repeated paracentesis or both. Shunt insertion was carried out via a percutaneous approach under local anesthesia.
Results: The procedure was well tolerated by all patients. The abdominal distention resolved in all patients, and urine volume increased significantly, demonstrating that the PVS did not affect renal function. The platelet count was reduced, and prothrombin time was prolonged. Two patients had the complication of shunt occlusion, and both patients underwent shunt replacement. There were no lethal complications. Median survival time after PVS placement was 21 days (range, 10∼90 days), and the shunt was functioning at the time of death with good control of ascites in all patients.
Conclusions: Malignant ascites produces troublesome symptoms for patients, who may live for some time. Placement of a PVS is a well-tolerated, relatively minor surgical procedure that can provide excellent control of ascites in most patients selected. The selection of optimal patients requires further study.

J Nippon Med Sch 2007; 74: 355-358

Keywords
malignant ascites, peritoneovenous shunt, percutaneous approach

Correspondence to
Yasuhiro Mamada, Department of Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
mamachan@nms.ac.jp

Received, June 5, 2007
Accepted, June 27, 2007