Improved Quality of Life for Malignant Ascites Patients by Denver Peritoneovenous Shunts

Background: Intractable ascites secondary to malignant disease deteriorates the patients' quality of life. Patients and Methods: Thirty-three patients, who had undergone Denver peritoneovenous shunt for the treatment of ascites associated with malignant tumor from May 1998 to February 2004, were retrospectively analyzed. Results: Post-operative complications had occurred in twelve patients, including disseminated intravascular coagulation in eight, pulmonary edema in three and wound hematoma in one. The patients' post-operative mean survival was 54.5 days with occlusion occurring in four (12.1%). Comparison of pre- and post- operative values showed a significant decrease of body weight and abdominal girth. Thirteen patients needed no post-operative therapy for ascites, whereas 17 patients could tentatively remain at home or be discharged. Conclusion: The Denver shunt for malignant ascites is useful in improving quality of life, if indications are selected properly. Further experience and discussion are necessary to establish the patient selection criteria. Malignant asictes associated with neoplasm has been observed to adversely effect the quality of life in patients who are at the terminal stage of malignant disease. Ascites in patients with malignancy is particularly difficult to control by conventional therapies, including that of restriction of sodium and water or by the use of diuretic agents. Paracentesis has been used as a procedure for managing such ascites, however the efficacy is quite temporary and may culminate in loss of proteins and electrolytes. Therefore, it is essential to establish the appropriate therapeutic strategies for treatment of malignant ascites. Since LeVeen et al. first reported the palliation of refractable ascites by peritoneovenous shunt in 1974 (1), a number of modifications have been made.The Denver peritoneovenous shunt (Denver shunt) has proven to be one of the most popular procedures among such modified techniques, because of the simplicity of the method and of the low frequency of shunt failure. Several reports of its efficacy in the treatment of ascites due to liver disease have appeared, but it has been used infrequently for the management of malignant ascites. In this paper, our experiences with 33 patients, in whom the Denver shunt had been employed to treat malignant ascites, are reported.