Clinical StudyTherapeutic Application of Percutaneous Peritoneovenous (Denver) Shunt in Treating Chylous Ascites in Cancer Patients
Section snippets
Study Design
This retrospective study was conducted under an exemption from the institutional review board. Data from 28 patients with refractory CA who were treated with percutaneous peritoneovenous shunt (PPVS) placement between April 2001 and June 2015 were reviewed.
CA was defined by milky appearance of the ascites with an ascitic fluid triglyceride concentration > 110 mg/dL. The peritoneal fluid was evaluated for cytology, culture, and triglyceride level before shunt placement at the time of
Results
PPVS placement was performed in 28 patients with CA. All patients were initially treated with conservative measures for a mean duration of 71 days ± 65 (range, 9–313 d). Conservative management included diet modification (32%), total parenteral nutrition (14%), diuretic therapy (46%), octreotide injection (7%), and repeated paracentesis (86%), used alone or in combinations. Demographic characteristics are listed in Table 1. Testicular cancer (39%) was the most common primary tumor. Surgery,
Discussion
Despite satisfactory reports on shunt placement, its role in treatment of CA is controversial. In this study, intractable CA was successfully managed with Denver shunt placement in 26 of 28 (93%) patients with cancer who had failed conservative management.
A search of the literature using MEDLINE revealed 56 reported cases of CA treated with peritoneovenous shunt (LeVeen and Denver) placement (Table 3). These reports demonstrate that PPVS placement is effective in treating CA in 96.4% of
Acknowledgment
The authors thank Sahra Emamzadeh-Fard, MD, for her help with data collection.
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2022, European Journal of Surgical OncologyCitation Excerpt :Paiella et al. used it systematically in cases where the conservative treatments were ineffective without reporting their results with this strategy [42]. The use of peritoneovenous (LeVeen or Denver) shunts has been reported after abdominal surgery with variable success rate [57,58]. It can be considered an option for patients who are refractory to medical therapy.
Transjugular Intrahepatic Portosystemic Shunt for the Treatment of Portal Hypertension-Induced Refractory Ascites Due to Metastatic Carcinomatous Liver Disease
2018, Journal of Vascular and Interventional RadiologyCitation Excerpt :This report highlights the potential role of TIPS creation, with the use of dedicated e-PTFE–covered stent grafts (8), as a palliative treatment for patients with refractory ascites due to cancer-related pseudocirrhosis–induced portal hypertension. Indeed, in the first 2 patients, the refractory ascites disappeared for several months until the ascites became malignant; therefore, TIPS might be a valuable alternative to repeated paracentesis, placement of an indwelling tunneled peritoneal catheter for regular ascitic fluid drainage (9), or creation of a Denver shunt (10,11). Finally, TIPS may have the potential to keep the patient out of hospital and might improve patients’ quality of life, although no dedicated analysis was performed regarding this topic.
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G.I.G. is a member of the Medical Board of Advisors for CareFusion Corporation (San Diego, California). None of the other authors have identified a conflict of interest.