Universität zu Köln

Stroehlein, M. A. (2010). Pleural Effusions and Ascites - Surgical and Palliative Aspects. Zent.bl. Chir., 135 (6). S. 508 - 516. STUTTGART: GEORG THIEME VERLAG KG. ISSN 1438-9592

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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. Conclusion: Various options for treatment of pleural effusions and ascites are available. Carful evaluation of the individual patient is necessary to improve quality of life and survival.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Stroehlein, M. A. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-492162
DOI:	10.1055/s-0030-1262681
Journal or Publication Title:	Zent.bl. Chir.
Volume:	135
Number:	6
Page Range:	S. 508 - 516
Date:	2010
Publisher:	GEORG THIEME VERLAG KG
Place of Publication:	STUTTGART
ISSN:	1438-9592
Language:	German
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language INTRAHEPATIC PORTOSYSTEMIC SHUNT; MALIGNANT ASCITES; REFRACTORY ASCITES; PROGNOSTIC-FACTORS; TALC PLEURODESIS; ACCESSORY CELLS; NATURAL-HISTORY; ADULT PATIENTS; SMALL-BORE; MANAGEMENT Multiple languages Surgery Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/49216