Ascites in Mesothelioma: Shunt Improves Quality of Life

A shunt that drains excess fluid out of the abdomen is a safe and effective way to relieve the symptoms of ascites in mesothelioma patients. That’s according to a new report published in Cancer Research and Therapeutics. 

Ascites is a buildup of fluid in the abdomen. It is a common side effect of peritoneal mesothelioma that can negatively impact quality of life. 

But a team of Japanese researchers say an intervention called the Denver shunt can alleviate ascites in mesothelioma and other cancers. It can do so without some of the downsides of other methods. In the right people, the shunt does not tend to cause serious complications. The researchers say the key to success is careful patient selection. 

What is Ascites in Mesothelioma?

Peritoneal mesothelioma is a cancer of the membrane around abdominal organs. Past exposure to asbestos is the number one risk factor for mesothelioma. As the cancer grows, it often triggers ascites in mesothelioma patients. 

Ascites is also called peritoneal effusion. It is a buildup of fluid in the abdomen. Patients with breast, gallbladder, pancreatic or other types of cancer may also develop effusion. It can make patients look and feel bloated and uncomfortable. Ascites in mesothelioma may also cause nausea, vomiting, weight gain, and exhaustion. 

One way to deal with peritoneal effusion is to drain the fluid as it collects. This can be done with a needle or a catheter. Another option is to reroute the fluid with a percutaneous peritoneovenous (Denver) shunt. 

Rerouting Abdominal Fluid with the Denver Shunt

One downside of removing ascites in mesothelioma patients, is that it may contain nutrients that mesothelioma patients need. It is also inconvenient. The Denver shunt gets around these problems by rerouting the fluid instead of removing it. 

Doctors use a minimally invasive procedure to place the shunt. A pump chamber continually moves the fluid from the abdomen into a vein. This way, it circulates in the blood. The nutrients stay in the body and wastes move out in the urine.

The new Japanese study included 35 cancer patients. The patients got Denver shunts between 2014 and 2017 for ascites in mesothelioma or another cancer. The team analyzed how well they did. 

Twenty-nine patients had less external bloating with the shunt. Forty percent had complications. These were most common in people with advanced cancer and higher ascites volume. It turned out that fluid volume alone was the biggest independent risk factor for complications. 

“The Denver shunt for malignant ascites is useful for improving patients’ quality of life if the indications are selected properly,” writes author Hiroshi Tamagawa with Kamishirane Hospital in Yokohama. “Further experience and discussion are necessary to establish the patient selection criteria.”

About a third to a fifth of mesothelioma patients have the peritoneal variety. Ascites in mesothelioma is not confined to these patients. Pleural mesothelioma patients can also develop excess fluid. Pleural effusion collects around the lungs and makes it harder to breathe. 

Sources:

Tamagawa, H, et al, “Therapeutic results of Denver percutaneous peritoneovenous shunt in cancer patients with malignant ascites”, December 2020, Journal of Cancer Research and Therapeutics, https://www.cancerjournal.net/article.asp?issn=0973-1482;year=2020;volume=16;issue=8;spage=95;epage=98;aulast=Tamagawa