Therapeutic Application of Percutaneous Peritoneovenous (Denver) Shunt in Treating Chylous Ascites in Cancer Patients

Abstract

Purpose: To evaluate the safety and efficacy of percutaneous peritoneovenous shunt (PPVS) placement in treating intractable chylous ascites (CA) in patients with cancer.

Materials and methods: Data from 28 patients with refractory CA treated with PPVS from April 2001 to June 2015 were reviewed. Demographic characteristics, technical success, efficacy, laboratory values, and complications were recorded. Univariate and multivariate logistic regression analysis was performed.

Results: Technical success was 100%, and ascites resolved or symptoms were relieved in 92.3% (26 of 28) of patients. In 13 (46%) patients with urologic malignancies, whose ascites had resulted from retroperitoneal lymph node dissection, the ascites resolved, resulting in shunt removal within 128 days ± 84. The shunt provided palliation of symptoms in 13 of the remaining 15 patients (87%) for a mean duration of 198 days ± 214. Serum albumin levels increased significantly (21.4%) after PPVS placement from a mean of 2.98 g/dL ± 0.64 before the procedure to 3.62 g/dL ± 0.83 (P < .001). The complication rate was 37%, including shunt malfunction/occlusion (22%), venous thrombosis (7%), and subclinical disseminated intravascular coagulopathy (DIC) (7%). Smaller venous limb size (11.5 F) and the presence of peritoneal tumor were associated with a higher rate of shunt malfunction (P < .05). No patient developed overt DIC.

Conclusions: PPVS can safely and effectively treat CA in patients with cancer, resulting in significant improvement in serum albumin in addition to palliation of symptoms.

Figure 1

A-D. Laboratory values. 1A. Demonstrating changes in the Albumin levels at three different timings: Preop = in the 3 weeks times prior to the procedure; Post op immed = at the 1 week follow up and post op latest = at one month follow up evaluation. Figure 1B. Demonstrates the changes in platelet counts: Preop = in the 48 hours prior to the procedure; Postop 12 hrs = at the night of the procedure; Post Op 24 hrs = counts the next morning after the procedure; Post Op 48 hrs = counts 2 days after the procedure; Post Op 72 hrs = 3 days after the procedure; Post Op Discharge = at one week follow up; Post op Latest = at one month follow up. 1C. Fibrinogen level and 6 different period of time; PreOp: In the same day, prior to the procedure; Immed Post: Fibrinogen values at the night of the procedure, At 24 hrs = counts the next morning after the procedure; At 36 hrs = counts the next night after the procedure; At 48 hrs = 2 days after the procedure, Latest = at one month post procedure. Figure 1 D. Prothrombin level at three periods of time: PreOp: on the day of the procedure, prior to the procedure, Post Op Immed = at the night of the procedure and Post Op Latest = one month after the procedure in follow up clinic visit.

Figure 1

A-D. Laboratory values. 1A. Demonstrating changes in the Albumin levels at three different timings: Preop = in the 3 weeks times prior to the procedure; Post op immed = at the 1 week follow up and post op latest = at one month follow up evaluation. Figure 1B. Demonstrates the changes in platelet counts: Preop = in the 48 hours prior to the procedure; Postop 12 hrs = at the night of the procedure; Post Op 24 hrs = counts the next morning after the procedure; Post Op 48 hrs = counts 2 days after the procedure; Post Op 72 hrs = 3 days after the procedure; Post Op Discharge = at one week follow up; Post op Latest = at one month follow up. 1C. Fibrinogen level and 6 different period of time; PreOp: In the same day, prior to the procedure; Immed Post: Fibrinogen values at the night of the procedure, At 24 hrs = counts the next morning after the procedure; At 36 hrs = counts the next night after the procedure; At 48 hrs = 2 days after the procedure, Latest = at one month post procedure. Figure 1 D. Prothrombin level at three periods of time: PreOp: on the day of the procedure, prior to the procedure, Post Op Immed = at the night of the procedure and Post Op Latest = one month after the procedure in follow up clinic visit.

Figure 1

A-D. Laboratory values. 1A. Demonstrating changes in the Albumin levels at three different timings: Preop = in the 3 weeks times prior to the procedure; Post op immed = at the 1 week follow up and post op latest = at one month follow up evaluation. Figure 1B. Demonstrates the changes in platelet counts: Preop = in the 48 hours prior to the procedure; Postop 12 hrs = at the night of the procedure; Post Op 24 hrs = counts the next morning after the procedure; Post Op 48 hrs = counts 2 days after the procedure; Post Op 72 hrs = 3 days after the procedure; Post Op Discharge = at one week follow up; Post op Latest = at one month follow up. 1C. Fibrinogen level and 6 different period of time; PreOp: In the same day, prior to the procedure; Immed Post: Fibrinogen values at the night of the procedure, At 24 hrs = counts the next morning after the procedure; At 36 hrs = counts the next night after the procedure; At 48 hrs = 2 days after the procedure, Latest = at one month post procedure. Figure 1 D. Prothrombin level at three periods of time: PreOp: on the day of the procedure, prior to the procedure, Post Op Immed = at the night of the procedure and Post Op Latest = one month after the procedure in follow up clinic visit.

Figure 1

A-D. Laboratory values. 1A. Demonstrating changes in the Albumin levels at three different timings: Preop = in the 3 weeks times prior to the procedure; Post op immed = at the 1 week follow up and post op latest = at one month follow up evaluation. Figure 1B. Demonstrates the changes in platelet counts: Preop = in the 48 hours prior to the procedure; Postop 12 hrs = at the night of the procedure; Post Op 24 hrs = counts the next morning after the procedure; Post Op 48 hrs = counts 2 days after the procedure; Post Op 72 hrs = 3 days after the procedure; Post Op Discharge = at one week follow up; Post op Latest = at one month follow up. 1C. Fibrinogen level and 6 different period of time; PreOp: In the same day, prior to the procedure; Immed Post: Fibrinogen values at the night of the procedure, At 24 hrs = counts the next morning after the procedure; At 36 hrs = counts the next night after the procedure; At 48 hrs = 2 days after the procedure, Latest = at one month post procedure. Figure 1 D. Prothrombin level at three periods of time: PreOp: on the day of the procedure, prior to the procedure, Post Op Immed = at the night of the procedure and Post Op Latest = one month after the procedure in follow up clinic visit.