Massive neoplastic ascites

Peritoneal metastases frequently occur in primary or recurrent abdominal malignancy and are often associated with massive ascites, which determines severe abdominal bloating, respiratory distress, and poor quality of life in patients with few months of life. After the failure of traditional medical therapies, simple drainage is effective in providing temporary symptom relief but does not provide a durable solution. Several treatment options are available, but no standard treatment strategy has been established, and none of the treatments consistently showed the ability to extend life expectancy. This review focuses on outcomes and adverse events of simple drainage, catheter placement, intraperitoneal therapy, peritoneovenous shunting, hyperthermic intraperitoneal chemotherapy, early postoperative intraperitoneal chemotherapy, pressurized intraperitoneal aerosol chemotherapy, and cell-free and concentrated ascites reinfusion therapy. The choice between the available options for durable symptom management requires both care and caution in weighing risks and benefits according to the patient's life expectancy.