Peritoneovenous shunts palliate malignant ascites.

Fifty-five peritoneovenous shunts (PVS) were implanted in 45 patients (29 LeVeen and 26 Denver shunts). Seventy-five percent of patients experienced relief of symptoms referable to their ascites. The mean survival time post-shunt placement was 33 weeks; however, considerable variation was noted in survival times for the various tumor types (pancreas 7 weeks, ovary 71 weeks). Significant alterations in coagulation parameters consistent with subclinical disseminated intervascular coagulation (DIC) were present in all patients with functioning shunts. These coagulation changes have proven reliable indicators of shunt patency. Shunt revision was necessary in 18 percent of patients. No significant difference in shunt patency was detected when Denver and LeVeen shunts were compared. This experience indicates that PVS offers effective palliation without undue morbidity for malignant ascites. The best results can be expected in those patients with ovarian and breast primary tumors. Because of the short time from onset of disabling ascites until death, PVS is not indicated in the majority of patients with pancreatic cancer.