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Mechanisms of human tumor metastasis studied in patients with peritoneovenous shunts.
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1984
Year
Surgical OncologyTumor InnervationPathologySurgeryPeritoneovenous ShuntsTumor BiologyAbdominal PainOncologySecondary DepositsHepatobiliary TumorVascular SurgeryRadiation OncologyCancer ResearchHistopathologyMalignant DiseaseTumor MicroenvironmentTumoral PathologyHuman Tumor MetastasisTumor MetastasisMedicineMalignancies
Peritoneovenous shunting relieves abdominal pain from malignant ascites by returning fluid to circulation via a one‑way valve between the peritoneum and jugular vein, and despite limited patient numbers and heterogeneity, it offers unparalleled insight into human tumor metastasis mechanisms. In a cohort of 29 patients (15 autopsied) receiving peritoneovenous shunts, direct infusion of tumor cells did not uniformly produce metastases; those that did form were small, asymptomatic, and sometimes bypassed the first capillary bed, indicating the procedure is not hazardous and revealing unexpected metastatic patterns.
The technique of peritoneovenous shunting for the alleviation of abdominal pain and distension in malignant ascites due to inoperable cancer, returns the fluid to the circulation via a one-way, valved, anastomosis between the peritoneum and the jugular vein. Surprisingly, although the patients treated with this technique receive direct infusions of malignant tumor cells into the blood, this study of 29 patients, 15 of whom came to autopsy, shows that they did not all develop metastases, some being completely free of such lesions despite long survival. Even when metastases do form, they are small and clinically asymptomatic, and the technique is therefore not hazardous. In some patients, inert tumor cells identifiable by natural markers were recognized in the tissues, but no growing metastases were observed. In others, the distribution of secondary deposits was unexpected in that metastases did not form in the organ containing the first capillary bed encountered, although hematogenous metastases had formed in other organs. Despite the fact that various factors such as (a) the small numbers of patients treated with the technique; (b) the sensitive nature of studies on terminally ill patients; and (c) the absence of consistency in the sample population with regard to factors such as length of survival and site of neoplasm, combine to reduce the number of suitable cases for study, the approach has unrivaled power and interest for those seeking to understand mechanisms underlying tumor metastasis in humans.