On the treatment and prognosis of malignant ascites: is the survival time determined when the abdominal paracentesis is needed?

We review a series of 100 consecutive cases of malignancy treated for ascites with abdominal paracentesis. The results of treatment for ascites with intracavitary Thiotepa are reported for 23 patients. The temporary partial response rate was 8/23 (35%) patients. There were symptoms of intestinal obstruction in five patients (22%) treated with Thiotepa, and one of these patients died of intestinal obstruction. In 60% of autopsied patients there were abundant intestinal adhesions in the peritoneal cavity after Thiotepa. We concluded that Thiotepa is contraindicated for instillation into the peritoneal cavity. The median survival time for patients with carcinoma of the mammary gland was 47 days, carcinoma of the ovary 121 days, and carcinoma of the large intestine 54 days after the first abdominal paracentesis. We found that patients without clinical liver metastasis at the time of first abdominal paracentesis had almost three times longer median survival time than that of patients with metastatic liver. In four cases the immediate cause of death was a complication of an abdominal paracentesis.