title: [Supportive care for malignant ascites in palliative phase: Place of paracentesis and diuretics].
abstract: Malignant ascites, occurring in advanced stages of cancer, is linked with poor prognosis and can cause invalidating symptoms. Physiopathological mechanisms of ascites formation are complex and have yet to be fully elucidated. In most cases, ascites is due to peritoneal carcinomatosis in which vascular permeability is enhanced by VEGF production while lymphatic drainage decreases. Ascites can also be secondary to portal hypertension, for example in case of multiple liver metastases, or due to lymphatic obstruction. While paracentesis and diuretics are commonly used, their efficiency has never been compared in a randomized controlled study. Paracentesis brings immediate but temporary relief in over 90% of cases, and implies multiple hospitalizations. Literature reports ascites control by aldosterone alone or in association with furosemide. But, available data is controversial, and there is no predictive factor to identify patients that respond to diuretic treatment. The indication of diuretic treatment is left to the appreciation of physicians. Existing recommendations are old, and practices influenced by results obtained in non-neoplastic ascites. Additional evidences are required before guidelines can be established for the palliative management of malignant ascites.
authors.affiliation: Centre Oscar-Lambret, unité de soins palliatifs, 3, rue Frédéric-Combemale, 59020 Lille, France. Electronic address: v-gamblin@o-lambret.fr.
authors.forename: Vincent
authors.initials: V
authors.lastname: Gamblin
authors.affiliation: Centre Oscar-Lambret, unité de soins palliatifs, 3, rue Frédéric-Combemale, 59020 Lille, France.
authors.forename: Arlette
authors.initials: A
authors.lastname: Da Silva
authors.affiliation: Centre Oscar-Lambret, unité de soins palliatifs, 3, rue Frédéric-Combemale, 59020 Lille, France.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Villet
authors.affiliation: Centre Oscar-Lambret, département de cancérologie urologique et digestive, 3, rue Frédéric-Combemale, 59020 Lille, France.
authors.forename: Farid
authors.initials: F
authors.lastname: El Hajbi
mesh_terms: D000450:Aldosterone / Q000627:therapeutic use; D001201:Ascites / Q000209:etiology / Q000628:therapy*; D002199:Capillary Permeability; D004232:Diuretics / Q000627:therapeutic use*; D005665:Furosemide / Q000627:therapeutic use; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications; D010166:Palliative Care / Q000379:methods*; D019152:Paracentesis / Q000379:methods*; D042461:Vascular Endothelial Growth Factor A / Q000096:biosynthesis
chemical_list: D004232:Diuretics; D042461:Vascular Endothelial Growth Factor A; D000450:Aldosterone; D005665:Furosemide
keywords: Ascite maligne; Diuretics; Diurétiques; Malignant ascites; Paracentesis; Paracentèse