Copyright
©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Prognostic factors for peritoneovenous shunt placement for refractory ascites in liver cirrhosis
Akira Hamaguchi, Junji Ueda, Nobuhiko Taniai, Masato Yoshioka, Akira Matsushita, Satoshi Mizutani, Youich Kawano, Tetsuya Shimizu, Tomohiro Kanda, Takahiro Murokawa, Hideyuki Takata, Hiroyasu Furuki, Yuto Aoki, Mampei Kawashima, Toshiyuki Irie, Takashi Ono, Takahiro Haruna, Daigo Yoshimori, Hiroshi Yoshida
Akira Hamaguchi, Junji Ueda, Akira Matsushita, Youich Kawano, Tetsuya Shimizu, Takahiro Murokawa, Takashi Ono, Takahiro Haruna, Daigo Yoshimori, Hiroshi Yoshida, Department of Gastroenterological Surgery, Nippon Medical School, Tokyo 1138603, Japan
Nobuhiko Taniai, Masato Yoshioka, Department of Gastroenterological Surgery, Nippon Medical School Musashi Kosugi Hospital, Kanagawa 2118533, Japan
Satoshi Mizutani, Department of Gastrointestinal Surgery, Nippon Medical School Musashi Kosugi Hospital, Kanagawa 2118533, Japan
Tomohiro Kanda, Hiroyasu Furuki, Department of Gastrointestinal Surgery, Nippon Medical School Tama Nagayama Hospital, Tokyo 2068512, Japan
Hideyuki Takata, Department of Surgery, Nippon Medical School, Tokyo 1138603, Japan
Yuto Aoki, Mampei Kawashima, Toshiyuki Irie, Department of Gastroenterological Surgery, Nippon Medical School Chiba Hokusoh Hospital, Chiba 2701694, Japan
Author contributions: Hamaguchi A, Ueda J, and Yoshida H performed the data analysis and completed the manuscript writing; Taniai N, Yoshioka M, Matsushita A, Mizutani S, Kawano Y, Shimizu T, Kanda T, Murokawa T, Takata H, Furuki H, Aoki Y, Kawashima M, Irie T, Ohno T, Haruna T, and Yoshimori D contributed to the manuscript revision of all subsequent versions; all authors contributed to the study conception and design, and have read and approved the final version to be published.
Institutional review board statement: This study was approved by the Ethics Committee of Nippon Medical School Hospital, No. M-2024-190.
Informed consent statement: All the patients provide consent for treatment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: The datasets used and analyzed during the current study are available from the corresponding author upon reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Junji Ueda, MD, PhD, Department of Gastroenterological Surgery, Nippon Medical School, 5-1, Sendagi Bunkyo-ku, Tokyo 1138603, Japan.
junji0821@nms.ac.jp
Received: September 5, 2025
Revised: September 22, 2025
Accepted: October 29, 2025
Published online: December 7, 2025
Processing time: 90 Days and 0.1 Hours
BACKGROUND
Refractory ascites severely impairs quality of life in patients with liver cirrhosis (LC) and cancer-related peritonitis. For individuals who are intolerant to medical therapy and require frequent large-volume paracentesis, a peritoneovenous shunt (PVS) offers a potential treatment option. However, PVS placement is associated with high complication rates, perioperative mortality, and lacks well-defined indications.
AIM
To identify prognostic factors for PVS placement and develop a novel postoperative survival scoring model for LC with refractory ascites.
METHODS
A total of 100 patients who underwent PVS placement for refractory ascites due to LC in our department between 1998 and 2024 were analyzed. Patients were stratified into two groups: Those who survived more than 180 days after PVS placement (L-group) and those who survived for less than 180 days (S-group). Prognostic factors were compared between groups, and four variables (sex, age, Child-Pugh score, and liver volume) were selected for the creation of a new scoring system.
RESULTS
Significant differences between the S- and L-groups were observed for age, sex, Child-Pugh score and preoperative liver volume. Based on these variables, we developed a scoring system as follows: 1 point each for age ≥ 60 years, Child-Pugh score ≥ 10, female sex, and preoperative liver volume < 1057 mL. Patients scoring 0-2 points were classified as PVS grade A, and those scoring 3-4 points as PVS grade B. Survival analysis showed that overall survival was significantly higher in PVS grade A compared with PVS grade B. Multivariate analysis confirmed PVS grade as an independent prognostic factor.
CONCLUSION
The proposed PVS scoring system may be a useful tool for predicting postoperative prognosis following PVS placement in patients with LC and refractory ascites.
Core Tip: This study culminated in the proposal of a novel scoring system to predict prognosis after peritoneovenous shunt placement for refractory ascites in patients with liver cirrhosis. In an analysis of 100 cases, four prognostic factors were identified: Age ≥ 60 years; Child-Pugh score ≥ 10; female sex; and liver volume < 1057 mL. Patients were stratified into peritoneovenous shunt grade A (0-2 points) and grade B (3-4 points), with significantly better survival observed in grade A. This scoring system may support clinical decision-making and improve patient outcomes.
