Introduction:Malignant pleural disease (MPE) is a common complication of metastatic cancers. Malignant ascites (MA) is usually seen with cancers of intra-abdominal origin, owing to the presumed local and transmural spread. There is little known about the correlation of malignant effusion and ascites in the tumors originating from intra-abdominal organs and if there are any common disease patterns owing to similar embryological origins of pleura and peritoneum.

Methods:We reviewed data of all patients referred to our tertiary pleural service with suspected MPE secondary to gynaecological (ovarian/cervical/endometrial), gastrointestinal (oesophageal, gastric, intestinal) and pancreato-biliary cancers between Dec21-Dec22. Data of confirmed MPE patients were analysed to assess the incidence of MA in relation to MPE, need for intervention and the impact on prognosis.

Results:Of 168 patients diagnosed with confirmed MPE, 18/168 (10%) patients had gynaecological, 12/168 (7%) had gastrointestinal and 12/168 had pancreato-biliary cancer (total 42/168, 25%). 23/42 (54%) developed MA (16/23 gynaecological, 1/23 gastrointestinal, 6/23 pancreato-biliary) but only 13/23 (56%) required drainage compared to 40/42 (95%) of MPE. 10/23 (43%) patients developed MA before MPE. The prognosis after detection of MA was 48 weeks compared to 20 weeks for MPE. Once symptomatic, the prognosis for MA and MPE was 35 weeks and 16 weeks respectively. There was no statistically significant difference in prognosis between MA and MPE (?2: 0.05, p-value:0.81).

Conclusion:

Almost half of the patients with intra-abdominal malignancies can develop malignant effusion without ascites but the prognosis is not worse.