Absence of metastatic sequelae during long-term treatment of malignant ascites by peritoneo-venous shunting. A clinico-pathological report.

This communication records a remarkable case illustrating both the clinical value of peritoneo-venous shunting in the management of malignant ascites, and the unique opportunity afforded by this procedure for investigation of factors which influence metastatic colony formation by disseminating human tumour cells. The study of patients treated with peritoneo-venous shunts for the purpose of obtaining information on metastasis is ethically sound because such treatment is used solely for relief of the patient's clinical condition, and investigative procedures involving the patient are limited to those necessary for good clinical management. The patient we present survived for 27 months following insertion of a peritoneo-venous shunt, and for most of this time had a functioning shunt judged by clinical criteria. At autopsy she was found to have no established metastases in any organ, although viable, clonogenic cancer cells clearly capable of forming large secondary growths in the abdominal cavity were delivered directly into the bloodstream.