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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 21, 2015; 21(39): 10936-10947
Published online Oct 21, 2015. doi: 10.3748/wjg.v21.i39.10936
Evaluation and treatment of malignant ascites secondary to gastric cancer
Hiromichi Maeda, Michiya Kobayashi, Junichi Sakamoto
Hiromichi Maeda, Michiya Kobayashi, Cancer Treatment Center, Kochi Medical School, Kochi 783-8505, Japan
Junichi Sakamoto, Tokai Central Hospital, Sohara Higashijima-cho, Kakamigahara 504-8601, Japan
Author contributions: Maeda H wrote the manuscript; Kobayashi M and Sakamoto J contributed to conception of this study and revised the draft.
Supported by Non-profit Epidemiological and Clinical Research Organization.
Conflict-of-interest statement: There is no conflict of interest to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Junichi Sakamoto, MD, PhD, Tokai Central Hospital, Sohara Higashijima-cho, Kakamigahara, Gifu 504-8601, Japan.
Telephone: +81-58-3823101 Fax: +81-58-3820229
Received: April 23, 2015
Peer-review started: April 24, 2015
First decision: July 13, 2015
Revised: July 26, 2015
Accepted: September 13, 2015
Article in press: September 13, 2015
Published online: October 21, 2015

Malignant ascites affects approximately 10% of patients with gastric cancer (GC), and poses significant difficulties for both patients and clinicians. In addition to the dismal general condition of affected patients and the diversity of associated complications such as jaundice and ileus, problems in assessing scattered tumors have hampered the expansion of clinical trials for this condition. However, the accumulation of reported studies is starting to indicate that the weak response to treatment in GC patients with malignant ascites is more relevant to their poor prognosis rather than to the ascites volume at diagnosis. Therefore, precise assessment of initial state of ascites, repetitive evaluation of treatment efficacy, selection of suitable treatment, and swift transition to other treatment options as needed are paramount to maximizing patient benefit. Accurately determining ascites volume is the crucial first step in clinically treating a patient with malignant ascites. Ultrasonography is commonly used to identify the existence of ascites, and several methods have been proposed to estimate ascites volume. Reportedly, the sum of the depth of ascites at five points (named “five-point method”) on three panels of computed tomography images is well correlated to the actual ascites volume and/or abdominal girth. This method is already suited to repetitive assessment due to its convenience compared to the conventional volume rendering method. Meanwhile, a new concept, “Clinical Benefit Response in GC (CBR-GC)”, was recently introduced to measure the efficacy of chemotherapy for malignant ascites of GC. CBR-GC is a simple and reliable patient-oriented evaluation system based on changes in performance status and ascites, and is expected to become an important clinical endpoint in future clinical trials. The principal of treatment for GC patients with ascites is palliation and prevention of ascites-related symptoms. The treatment options are various, including a standard treatment based on the available guidelines, cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC), laparoscopic HIPEC alone, intravenous chemotherapy, intraperitoneal chemotherapy, and molecular targeting therapy. Although each treatment option is valid, further research is imperative to establish the optimal choice for each patient.

Keywords: Ascites, Clinical benefit, Gastric cancer, Peritoneal dissemination, Paclitaxel

Core tip: Malignant ascites affects approximately 10% of patients with gastric cancer (GC) and poses significant problems for treatment. Accurate and repetitive measurement of ascites volume during treatment is clinically imperative for effective decisions surrounding treatment continuation. Meanwhile, clinical benefit response in GC, a patient-oriented assessment framework of treatment efficacy, should be used in future clinical trials for malignant ascites caused by GC. Although several treatment options have been reported, further studies are mandatory to develop a solid and optimal treatment strategy.