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Malignant ascites: pathophysiology and treatment

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Abstract

Malignant ascites (MA) accompanies a variety of abdominal and extra-abdominal tumors. It is a primary cause of morbidity and raises several treatment challenges. MA has several symptoms, producing a significant reduction in the patient’s quality of life: loss of proteins and electrolyte disorders cause diffuse oedema, while the accumulation of abdominal fluid facilitates sepsis. Treatment options include a multitude of different procedures with limited efficacy and some degree of risk. A Pubmed, Medline, Embase, and Cochrane Library review of medical, interventional and surgical treatments of MA has been performed. Medical therapy, primarily paracentesis and diuretics, are first-line treatments in managing MA. Paracentesis is widely adopted but it is associated with significant patient discomfort and several risks. Diuretic therapy is effective at the very beginning of the disease but efficacy declines with tumor progression. Intraperitoneal chemotherapy, targeted therapy, immunotherapy and radioisotopes are promising medical options but their clinical application is not yet completely elucidated, and further investigations and trials are necessary. Peritoneal–venous shunts are rarely used due to high rates of early mortality and complications. Laparoscopy and hyperthermic intraperitoneal chemotherapy (HIPEC) have been proposed as palliative therapy. Literature on the use of laparoscopic HIPEC in MA includes only reports with small numbers of patients, all showing successful control of ascites. To date, none of the different options has been subjected to evidence-based clinical trials and there are no accepted guidelines for the management of MA.

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Abbreviations

MA:

Malignant ascites

VEGF:

Vascular endothelial growth factor

TNF:

Tumor necrosis factor

MMP:

Matrix metalloproteinases

IC:

Intraperitoneal chemotherapy

HIPEC:

Hyperthermic intraperitoneal chemotherapy

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The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Section of General and Emergency Surgery, Department of Surgery, “Santa Maria della Misericordia” Hospital, University of Perugia, School of Medicine, Via Gerardo Dottori, 1, 06132, Perugia, Italy

    Emanuel Cavazzoni, Walter Bugiantella, Luigina Graziosi & Annibale Donini

  2. Department of Radiology, “Santa Maria della Misericordia” Hospital, University of Perugia, School of Medicine, Via Gerardo Dottori, 1, 06132, Perugia, Italy

    Maria Silvia Franceschini

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  1. Emanuel Cavazzoni
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  2. Walter Bugiantella
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  3. Luigina Graziosi
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  4. Maria Silvia Franceschini
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  5. Annibale Donini
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Correspondence to Emanuel Cavazzoni.

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Cavazzoni, E., Bugiantella, W., Graziosi, L. et al. Malignant ascites: pathophysiology and treatment. Int J Clin Oncol 18, 1–9 (2013). https://doi.org/10.1007/s10147-012-0396-6

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