Managing Refractory Ascites in Advanced Liver Cancer Patients

Ascites is a common complication in patients with advanced liver cancer. The primary reasons for this condition include the following:

Tumor Growth and Rupture Leading to Malignant Ascites
As the tumor enlarges, it can cause malignant ascites. In some cases, if the tumor ruptures, blood may accumulate in the abdominal cavity, further contributing to fluid buildup.

Malnutrition and Hypoproteinemia
The liver is responsible for producing proteins, and when liver function declines due to cancer, protein production decreases. This leads to low protein levels in the blood, which contributes to fluid leakage into the abdominal cavity. Additionally, cancer-related cachexia in the late stages of the disease can worsen nutritional status, making ascites more severe and difficult to manage.

Initially, small amounts of ascites can often be managed with diuretics, helping the body eliminate excess fluid through urine. However, when diuretics are ineffective, alternative approaches are necessary.

Paracentesis for Fluid Drainage
In cases of refractory ascites, paracentesis—a procedure to remove fluid from the abdomen—may be performed. During this process, doctors typically drain 800–1000 mL of fluid per day to prevent excessive fluid loss and maintain the patient's stability.

Transjugular Intrahepatic Portosystemic Shunt (TIPS)
For long-term management, a TIPS procedure may be considered. This minimally invasive surgery creates a shunt between the hepatic vein and the portal vein, effectively reducing portal hypertension and decreasing ascites accumulation.

It is crucial to tailor treatment strategies based on the patient's overall condition, liver function, and disease progression to ensure both comfort and quality of life.