title: [Pleural effusions and ascites--surgical and palliative aspects].
abstract: BACKGROUND
  Pleural effusions and ascites are associated with distressing symptoms like dyspnoea, intestinal obstruction, vomiting, nausea and pain. In patients with underlying malignancy, the prognosis is limited to few months. After unsuccessful medical treatment, surgical and experimental palliative treatment is indicated.
  
  
  METHODS
  This review includes a systematic analysis of surgical, experimental and palliative options.
  
  
  RESULTS
  In patients with pleural effusions, thoracocentesis, permanent percutaneous drainage, thoracoperitoneal shunts as well as pleurodesis by tubes or thoracoscopy are available, which will be used depending on the re-expansion of the lung. In patients with ascites, paracentesis is able to control acute symptoms. For long-lasting treatment, portosystemic shunts (TIPS) are favourable for patients with liver cirrhosis. Peritoneovenous shunts can be implanted by laparotomy, but are correlated with high rates of complications and occlusions. In patients with malignancy, pleural effusions and ascites may also be controlled by complete cytoreductive surgery and hyperthermic chemoperfusion. This aggressive surgical concept is limited to single carefully selected patients. In malignant ascites, intraperitoneal immunotherapy by catumaxomab is a novel and highly effective option, which controls ascites by targeted destruction of peritoneal cancer cells.
  
  
  CONCLUSIONS
  Various options for treatment of pleural effusions and ascites are available. Careful evaluation of the individual patient is necessary to improve quality of life and survival.
authors.affiliation: Klinikum Köln-Merheim, Universitätsklinikum der Universität Witten/Herdecke, Köln, Deutschland. stroehleinm@kliniken-koeln.de
authors.forename: M A
authors.initials: MA
authors.lastname: Ströhlein
mesh_terms: D018033:Antibodies, Bispecific / Q000008:administration & dosage; D000970:Antineoplastic Agents / Q000008:administration & dosage; D001201:Ascites / Q000601:surgery*; D010478:Chemotherapy, Cancer, Regional Perfusion; D015505:Chest Tubes; D003131:Combined Modality Therapy; D004322:Drainage / Q000379:methods; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods; D008103:Liver Cirrhosis / Q000601:surgery; D009369:Neoplasms / Q000601:surgery*; D010166:Palliative Care / Q000379:methods*; D019152:Paracentesis / Q000379:methods; D016066:Pleural Effusion, Malignant / Q000601:surgery*; D018700:Pleurodesis / Q000379:methods; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000379:methods; D013906:Thoracoscopy / Q000379:methods
chemical_list: D018033:Antibodies, Bispecific; D000970:Antineoplastic Agents; C522419:catumaxomab