Therapeutic results of Denver percutaneous peritoneovenous shunt in cancer patients with malignant ascites
Hiroshi Tamagawa1, Toru Aoyama2, Hirohide Inoue1, Hirohito Fujikawa1, Sho Sawazaki2, Masakatsu Numata2, Tsutomu Sato2, Takashi Oshima2, Norio Yukawa2, Manabu Morimoto3, Makoto Ueno3, Yashushi Rino2, Munetaka Masuda2
1 Department of Surgery, Kamishirane Hospital, Yokohama, Japan
2 Department of Surgery, Yokohama City University, Yokohama, Japan
3 Department of Gastroenterology, Hepatobiliary and Pancreatic Medical Oncology Division, Kanagawa Cancer Center, Yokohama, Japan
Department of Surgery, Kamishirane Hospital, 2-65-1 Kamishirane, Asahi, Yokohama 241-0002
Source of Support: None, Conflict of Interest: None
Background: Intractable ascites secondary to malignant disease deteriorates patients' quality of life. The purpose of this study was to evaluate the safety and efficacy of percutaneous peritoneovenous (Denver) shunt in treating intractable malignant ascites in cancer patients.
Materials and Methods: Thirty-five patients who had undergone Denver peritoneovenous shunt for the treatment of ascites associated with malignant tumor from October 2014 to 2017 were retrospectively analyzed. The demographic characteristics, laboratory values, and complications were recorded. Univariate and multivariate logistic regression analyses were performed.
Results: The sites of primary tumor were pancreatic cancer in 19 patients, bile duct cancer in 8, gallbladder cancer in 5, breast cancer in 2, and peritoneal malignant mesothelioma in 1. Palliation of abdominal distention was achieved in 29 patients (82.9%). Postoperative complications of Grade 2 or higher were seen in 11 patients (31.4%), and Grade 5 complications were observed in three patients (8.6%). Patients with a high American Society of Anesthesiologists (ASA) grade and high ascites drainage volume had a significantly higher incidence of postoperative complications than a low ASA grade and low ascites drainage volume, and a multivariate logistic analysis showed that the intraoperative ascites drainage volume was an independent risk factor for all complications.
Conclusions: The Denver shunt for malignant ascites is useful for improving patients' quality of life if the indications are selected properly. Drainage of intraoperative ascites was a risk factor for postoperative complications after the Denver shunt technique in cancer patients with malignant ascites. Further experience and discussion are necessary to establish the patient selection criteria.