Long term results (greater than 5 years) in patients with peritoneovenous shunting for intractable ascites: liver function and cancer mortality.
This report is based on twenty-eight (26%) of 107 patients included in a protocol for prospective evaluation of elective peritoneo-venous shunting for intractable ascites in cirrhosis. These patients had no other procedures and survived more than 5 years after the operation. All patients were free of ascites except one in whom it was mild. One patient refused follow-up. Shunt patency was assessed in 23 patients In 14 patients (60.9%), the shunt was obstructed and the superior vena cava was occluded in 5 of them. In 9 patients (39.1%), the shunt was still functioning. No clinical or biological parameters differentiated these two groups of patients. Of the 24 patients who were alcoholics, 2 abstained completely and 20 significantly reduced their drinking habits. In 25 patients, the Pugh's score improved and was A at the time of the study. Seven patients (25.9%) developed a malignant tumor of the oro-pharynx or digestive tract, all other patients were alive and in good health. This study suggests that patients with intractable ascites treated by a peritoneo-venous shunt may survive for a long period. In patients abstaining from heavy drinking, it may function as a therapeutic bridge permitting spontaneous improvement of liver function. The risk of supervening neoplasms suggests that a continuous follow-up of these patients is warranted.
Franco
D
D
Groupe de Recherche sur la Chirurgie du Foie et de l'Hypertension Portale, Hôpital Paul Brousse, Villejuif, France.
Meakins
J L
JL
Wu
A
A
Smadja
C
C
Bonnet
P
P
Gouffier
E
E
Campillo
B
B
D000328:Adult; D000368:Aged; D000428:Alcohol Drinking; D001201:Ascites / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008099:Liver / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000150:complications / Q000401:mortality / Q000601:surgery*; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications / Q000401:mortality / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000209:etiology / Q000401:mortality; D010536:Peritoneovenous Shunt / Q000009:adverse effects / Q000401:mortality*; D011183:Postoperative Complications; D015996:Survival Rate