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World J Gastrointest Surg. Apr 27, 2012; 4(4): 87-95
Published online Apr 27, 2012. doi: 10.4240/wjgs.v4.i4.87
Malignant ascites: A review of prognostic factors, pathophysiology and therapeutic measures
Suma L Sangisetty, Thomas J Miner
Suma L Sangisetty, Thomas J Miner, Department of Surgery, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI 02903, United States
Author contributions: All the two authors contributed to this review.
Correspondence to: Thomas J Miner, MD, FACS, Assistant Professor, Department of Surgery, Warren Alpert Medical School of Brown University, Rhode Island Hospital, 593 Eddy Street, APC443, Providence, RI 02903, United States.
Telephone: +1-401-444-2892 Fax: +1-401-444-6681
Received: June 2, 2011
Revised: December 31, 2011
Accepted: January 10, 2012
Published online: April 27, 2012

Malignant ascites indicates the presence of malignant cells in the peritoneal cavity and is a grave prognostic sign. While survival in this patient population is poor, averaging about 20 wk from time of diagnosis, quality of life can be improved through palliative procedures. Selecting the appropriate treatment modality remains a careful process, which should take into account potential risks and benefits and the life expectancy of the patient. Traditional therapies, including paracentesis, peritoneovenous shunt placement and diuretics, are successful and effective in varying degrees. After careful review of the patient’s primary tumor origin, tumor biology, tumor stage, patient performance status and comorbidities, surgical debulking and intraperitoneal chemotherapy should be considered if the benefit of therapy outweighs the risk of operation because survival curves can be extended and palliation of symptomatic malignant ascites can be achieved in select patients. In patients with peritoneal carcinomatosis who do not qualify for surgical cytoreduction but suffer from the effects of malignant ascites, intraperitoneal chemotherapy can be safely and effectively administered via laparoscopic techniques. Short operative times, short hospital stays, low complication rates and ultimately symptomatic relief are the advantages of laparoscopically administering heated intraperitoneal chemotherapy, making it not only a valuable treatment modality but also the most successful treatment modality for achieving palliative cure of malignant ascites.

Keywords: Carcinomatosis, Peritoneal, Paracentesis, Peritovenous shunts, HIPEC