engleski

Malignancy-related ascites ; clinical significance and impact on prognosis

The appearance of malignancy-related ascites usually heralds the onset of advanced disease and portends a poor prognosis. We conducted a retrospective study of 43 patients who underwent therapeutic abdominal paracentesis for malignancy-related ascites between October 1st, 2015 and March 31st, 2016 at our institution. The population included 23 males and 20 females with a mean age of 64 years (range, 22-81 years) diagnosed with metastatic disease, the most common of which included gastrointestinal cancer (28 patients) and ovarian cancer (7 patients). The sites of metastases at diagnosis of the ascites as demonstrated by diagnostic imaging techniques included liver (19 patients), lymph nodes (18 patients), peritoneum (13 patients), lung and pleura (5 patients), bones (3 patients), and rare metastatic sites (3 patients). The most frequent symptoms of the malignancy-related ascites were abdominal distension (90.7%), shortness of breath (34.9%), abdominal discomfort or pain (16.3%), leg swelling (16.3%), vomiting (11.6%), nausea (9.3%), constipation (4.7%) and general weakness (4.7%). The mean volume drained by paracentesis was 4000 milliliters per procedure (range, 1200 milliliters to 6000 milliliters). Diuretics were used in 30 patients with furosemide used in 29 (67.4%), spironolactone in 18 (41.9%) and combination of both in 17 (39.5%). None of the patients in this series had either continuous peritoneal ports or catheters drainage. The patients with gastrointestinal cancer had higher values of serum urea (13.6 mmol/L) than other (7.4 mmol/L) (p=0.0323). The values of serum urea in the patients with gastrointestinal cancer were also greater than in the patients with ovarian cancer (6.9 mmol/L) (p=0.0392). The patients with liver metastases on average were older (72 years) than the other patients (63 years) (p=0.0169), and had higher values of serum bilirubin (36.4 μmol/L) than other (10.6 μmol/L) (p=0.0292) as well. The patients with nausea had higher values of serum urea (20.15 mmol/L) than the other (7.8 mmol/L) (p=0.0384). The patients presented with swollen legs had signifi cantly lower INR than the other (p=0.0365). The survival period after the patients were diagnosed with ascites was between 2 and 339 days (the median value was 24 days). The patients with ovarian cancer had the average survival period of 93 days (between 5 and 339 days). The patients with gastrointestinal cancer had an average survival period of 35 days (between 2 and 201 days). Regarding the primary cancer diagnosis, the survival analysis showed a statistically signifi cant diff erence in the dynamics of mortality (p=0.0352). Three patients with ovarian cancer died within 20 days, and the other four lived for about a year. Nearly all patients with gastrointestinal cancer died within three months. After abdominal paracentesis, the patients with liver metastases lived for 19 days on average (3 to 149 days), while the patients without liver metastases lived for 86 days on average (2 to 339 days) (p=0.0120)

malignancy-related ascites ; paracentesis ; prognosis ; survival

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