The study, published in Science Immunology under the title “Multiomic analysis of malignant ascites defines RORC-expressing dendritic cells at sites of metastasis,” was co-led by Steven Blum, MD, and jointly supervised by Gary Reynolds, MD, PhD, Samuel Klempner, MD, and Alexandra-Chloé Villani, PhD, at the Krantz Family Center for Cancer Research within the Mass General Brigham Cancer Institute and the Mass General Brigham Center for Immunology & Inflammatory Diseases. The work was driven by a stark clinical reality. Roughly one in ten patients with advanced solid tumors will develop malignant ascites, and the complication is especially common in gastric and gastroesophageal cancers, where patients typically survive only a few months once fluid begins to accumulate. Ascites is associated with poor responses to both chemotherapy and immunotherapy, yet the reasons for that treatment resistance have remained poorly understood.

The clinical burden of ascites extends well beyond its grim prognosis. Because the fluid presses on the stomach and intestines, patients often cannot eat comfortably, and the repeated paracentesis procedures used to drain it are physically exhausting and logistically demanding. For many patients, the researchers note, drainage is essentially the only available option, and the removed fluid is simply thrown away. That practice, the team realized, represented a missed opportunity of unusual magnitude. Unlike a tumor biopsy, which samples a single fixed piece of tissue, ascites is a living suspension of the entire metastatic ecosystem: cancer cells floating freely, immune cells drawn to the site of disease, stromal elements, and a rich soup of soluble signaling proteins, all collected non-invasively in the course of routine care.

To exploit that opportunity, the investigators collected paired ascites and blood specimens directly from patients with stomach and esophageal cancers and built an experimental pipeline designed to capture both the abundant and the vanishingly rare members of that cellular community. The approach combined single-cell RNA sequencing, which records which genes are active in each individual cell, with measurements of proteins on cell surfaces, sequencing of immune receptors, and profiling of the soluble proteins present in both blood and ascites fluid. The resulting primary dataset encompassed more than 500,000 cells, an unusually deep census of a metastatic environment, and the team went on to develop methods for physically isolating one of the rare populations they discovered so that it could be studied in primary tumors and lymph nodes as well.

The first conceptual conclusion of the study is deceptively simple but potentially far-reaching: malignant ascites is not merely plasma that has leaked out of the bloodstream carrying a few stray cancer cells. Instead, the analysis showed it to be a distinct and highly organized immune environment in its own right, one that actively shapes how the immune system responds to cancer. The immune cells found in ascites were not a passive reflection of what circulates in blood; they carried gene-expression programs, surface-protein signatures, and receptor repertoires consistent with a locally organized immunological niche. Some of the signaling pathways the team identified are already targetable with existing drugs, raising the possibility that such agents could be repositioned for ascites patients, potentially by delivering them directly into the abdominal cavity where the fluid collects.

The most striking discovery, however, was a rare population of dendritic cells expressing the gene RORC, which the authors termed RORC-expressing dendritic cells, or RORC DCs. Dendritic cells are the sentinels of the immune system, best known for gobbling up debris and presenting fragments of it to T cells, thereby launching immune attacks. The RORC DCs found in ascites represented only a tiny fraction of the immune cells present, yet they were remarkably consistent: the cells were detected in 22 of the 23 patients in the initial cohort. That near-universal presence, despite their scarcity, suggested they are not random contaminants but a reproducible feature of the metastatic peritoneal environment.

What makes the finding biologically provocative is what these cells resemble. RORC DCs bear similarities to a family of immune cells recently characterized in mice and humans that has been shown to help establish immune tolerance, the set of mechanisms that prevents the immune system from attacking harmless substances or the body’s own tissues. Those tolerance-associated cells are exceptionally rare in healthy human tissues and had never previously been connected to cancer. The authors’ experiments suggest that RORC DCs may represent an underappreciated cell type that promotes immune tolerance within tumors, essentially a cellular brake on anti-cancer immunity operating at the very sites where metastatic disease takes hold.

That hypothesis reframes a fundamental tension in immunology. Tolerance mechanisms are not pathological; they are essential, protecting everyone from autoimmunity and destructive inappropriate inflammation. But cancer, the researchers propose, may exploit the very same biology. In metastatic disease, a normally protective immune program could help create an environment in which T cells are less effective at recognizing and killing cancer cells, which would help explain why patients with ascites respond so poorly to immunotherapies designed to unleash T cells. If RORC DCs are indeed helping to impose that tolerant state, they offer an entirely new area of biology to investigate and, potentially, an entirely new class of therapeutic target.

The authors are careful to note that the findings will not change clinical care today. The work is an early step, and its immediate value lies in reimagining how patients with malignant ascites are studied and, eventually, treated. The team has identified pathways and candidate therapeutic targets that are now being evaluated in patient-derived laboratory models, with the hope that the most promising approaches can be brought back to patients through clinical trials. Key open questions include what RORC DCs are actually doing in the ascites environment, where they originate, and whether their activity can be safely modified. Answering those questions, the researchers argue, could uncover new ways to strengthen anti-cancer immunity in a patient population they describe as severely underserved.

Beyond the specific discovery, the study carries a broader methodological lesson for oncology. Ascites arises not only in gastric and gastroesophageal cancers but across many tumor types that metastasize to the abdominal cavity, and the researchers found that the immune populations they identified in stomach and esophageal cancer samples were also present in ascites from other cancers and at other sites of metastatic disease. That suggests the fluid could serve as a general-purpose sampling platform for metastatic immunology, one that requires no additional invasive procedure beyond the drainage patients already undergo. A substance long treated as waste, in other words, may prove to be one of the most detailed maps available of how cancer and the immune system negotiate their uneasy coexistence, and the rare cells drifting within it may hold clues to why the immune system so often stands down precisely when it is needed most.

Subject of Research: Immune cell analysis of malignant ascites in metastatic cancer

Article Title: New study turns attention to a common problem across cancers: malignant ascites

Article References: New study turns attention to a common problem across cancers: malignant ascites. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: malignant ascites, dendritic cells, RORC, immune tolerance, metastatic cancer, single-cell RNA sequencing, gastric cancer, gastroesophageal cancer, immunotherapy, tumor microenvironment, Science Immunology, Mass General Brigham

The raw material for the new models is malignant ascites, the fluid that accumulates in the peritoneal cavity when cancer cells seed the abdominal lining. Ascites is clinically accessible through routine paracentesis, and it is rich in viable tumor cells shed from peritoneal deposits, making it an attractive biopsy surrogate for patients who are too advanced for surgery. Conventional two-dimensional cell cultures, however, strip away the architecture and cell-cell interactions that define how tumors behave, and patient-derived xenografts take months to establish in mice, far too slow to inform a first-line treatment decision. The researchers set out to bridge that gap with extrusion-based three-dimensional bioprinting, a technique that deposits living cells suspended in a soft hydrogel in precise, layered patterns.

The bioink at the heart of the system combines two photo-crosslinkable materials: gelatin methacryloyl, known as GelMA, and hyaluronic acid methacryloyl, or HAMA. GelMA is derived from gelatin and carries methacrylate groups that polymerize under light, giving the printed construct mechanical stability while its cell-adhesive motifs, inherited from native collagen, allow tumor cells to attach, migrate and organize. HAMA contributes a hydrated, hyaluronic-acid-rich matrix that mimics components of the tumor microenvironment and helps regulate stiffness and porosity. A photoinitiator called lithium phenyl-2,4,6-trimethylbenzoylphosphinate triggers crosslinking under visible light during printing, so the structure solidifies gently enough to keep cells alive. Ascites-derived cells were mixed directly into this hydrogel blend, and the resulting ink was printed into small constructs in a process the authors report took less than six hours from sample processing to finished model.

Speed matters because the clinical window for treatment decisions in metastatic gastric cancer is narrow. The printed constructs proved remarkably self-organizing: within seven to ten days in culture, the embedded malignant cells reconstituted organized glandular-like structures or solid tumor architectures, echoing the histological patterns of the parent tumors. The models remained viable for at least two weeks, a sufficient window to run full dose-response experiments. In 13 of 14 patient cases, or 92.9 percent, the team successfully established a bioprinted model, a success rate that compares favorably with organoid cultures and far exceeds the yield of xenograft approaches for this disease stage.

Establishing that the models faithfully represent each patient’s cancer was the central analytical challenge. The researchers performed immunohistochemistry on the printed constructs and found preservation of core gastric cancer markers, including the intestinal lineage transcription factor CDX2 and the carcinoembryonic antigen CEA. More therapeutically important, the expression patterns of three clinically actionable biomarkers, HER2, PD-L1 and Claudin 18.2, were generally consistent between the bioprinted models and the parental tumors. These are the targets that determine eligibility for HER2-directed antibodies, immune checkpoint inhibitors and Claudin 18.2-directed therapies, so their retention in the model is a prerequisite for any claim that the platform can guide treatment selection.

Genomic fidelity was assessed with whole-exome sequencing. The team compared somatic single-nucleotide variants detected in the bioprinted models with those in the parental ascites samples and found that key genomic features were preserved. To quantify this, they correlated the variant allele frequencies of mutations shared between each model and its parent sample, obtaining a median Pearson correlation coefficient of 0.817, with values ranging from 0.679 to 0.921. Variant allele frequency reflects the proportion of sequencing reads carrying a mutation and serves as a proxy for the cellular composition of a sample, so a high correlation indicates that the printed construct recapitulates not just which mutations are present but in what proportions. For a model built from a heterogeneous fluid containing tumor cells, immune cells and stromal elements, that degree of concordance is a strong indicator of faithful representation.

With fidelity established, the platform was put to its intended use: drug sensitivity testing. The researchers exposed each patient’s model to the standard chemotherapeutic backbone for gastric cancer, including oxaliplatin, fluorouracil and paclitaxel, and measured viability across a range of concentrations. Dose-response curves were fitted with a four-parameter logistic model, and the area under the curve, or AUC, was calculated as a summary metric of drug response, with lower values indicating greater sensitivity. The results revealed marked inter-patient heterogeneity: models from different patients responded very differently to the same agents, mirroring the unpredictable treatment responses seen in the clinic and underscoring why one-size-fits-all regimens so often fail in peritoneal disease.

To translate continuous dose-response data into a clinically interpretable verdict, the team needed a decision boundary. They derived an exploratory normalized AUC threshold of 0.675 using the Jenks natural breaks method, a statistical classification technique that identifies natural groupings within a data distribution by minimizing within-class variance and maximizing between-class variance. Applying this threshold, each model’s response to each drug was classified as sensitive or resistant. When the researchers compared these in vitro classifications with the clinical outcomes of the corresponding patients, the results were generally consistent, suggesting that the printed models captured enough of each tumor’s drug biology to predict, at least in an exploratory sense, whether a given agent would help or fail.

The authors are careful to frame the threshold as exploratory rather than validated. A single-arm study of 14 patients cannot establish predictive accuracy with the statistical rigor required for clinical deployment, and the concordance between in vitro classification and clinical outcome will need to be confirmed in larger, prospective cohorts with predefined endpoints such as progression-free survival and overall survival. Questions also remain about how the ascites microenvironment, including immune and stromal cells that may or may not survive the printing process, influences drug responses, and whether the platform can be extended to targeted agents and immunotherapies beyond cytotoxic chemotherapy. The open-access study was conducted under approval from the Medical Ethics Committee of Peking Union Medical College Hospital with written informed consent from all participants, and the authors declare no competing interests.

Even with those caveats, the work represents a meaningful advance in translational cancer modeling. It demonstrates that a clinically obtainable fluid, processed within hours into a bioprinted three-dimensional construct, can reproduce the histological, biomarker and genomic identity of a patient’s gastric cancer and yield drug-response data on a timescale compatible with real treatment decisions. If validated at scale, ascites-derived bioprinted models could give oncologists caring for patients with peritoneal metastasis something they currently lack: a personalized, functional readout of which chemotherapy is likely to work before the first dose is given. The study was supported by the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences, the National High Level Hospital Clinical Research Funding, the Peking Union Medical College Hospital Talent Cultivation Program and the Ningbo Major Research and Development Plan Project.

Subject of Research: 3D bioprinted patient-derived ascites models for drug sensitivity testing in gastric cancer with peritoneal metastasis

Article Title: 3D bioprinted ascites-derived models for gastric cancer patients with peritoneal metastasis

Article References: Hua, Y., Du, L., Sun, H., Sun, M., Pang, M., Jiang, S., Zhang, K., Lu, Y., Mao, Y., Sun, Z., Ge, Y., Nie, M., Wang, C., Wang, X., Yao, G., Yang, D., Bai, C., Yang, H., & Zhao, L. (2026). 3D bioprinted ascites-derived models for gastric cancer patients with peritoneal metastasis. Journal of Translational Medicine. https://doi.org/10.1186/s12967-026-08953-x

Image Credits: AI Generated

DOI: 10.1186/s12967-026-08953-x

Keywords: 3D bioprinting, gastric cancer, peritoneal metastasis, malignant ascites, drug sensitivity testing, bioink, GelMA, HAMA, whole-exome sequencing, patient-derived models, precision oncology, hydrogels

Malignant ascites, the pathological accumulation of fluid in the peritoneal cavity, is a hallmark of advanced disease and signals rapid progression and metastatic spread. Standard interventions, including cytotoxic agents such as cisplatin and anti-angiogenic drugs like bevacizumab, typically provide only transient relief, and fluid reaccumulation remains common. The researchers sought a strategy that could simultaneously attack the tumor and suppress fluid production, while sidestepping the toxicity that limits conventional regimens. Their attention turned to the PI3K/AKT/mTOR signaling pathway, a master circuit governing tumor proliferation, survival, angiogenesis, and metastasis that is frequently hyperactivated in hepatocellular carcinoma through gene mutations, epigenetic changes, and upstream receptor dysregulation. Because the pathway is also implicated in treatment resistance, it represents an attractive therapeutic bullseye.

The team’s mechanistic insight centered on choline metabolism, a well-documented hallmark of cancer. Rapidly dividing malignant cells ramp up phosphocholine biosynthesis to meet relentless demands for new membrane material. Choline kinase alpha, the rate-limiting enzyme in this pipeline, is markedly overexpressed in hepatocellular carcinoma and is functionally entwined with PI3K/AKT signaling, where it mediates interactions between the epidermal growth factor receptor and mTORC2 that promote drug resistance and tumor progression. Disrupting the choline-metabolic axis, the researchers reasoned, could starve tumors of structural building blocks while severing their survival signaling. What they needed was a delivery platform that would keep the drug where it was needed, inside the peritoneal cavity, for as long as possible.

The answer emerged from an unlikely corner of pharmacological history. Euphorbia pekinensis Rupr. and Radix Glycyrrhizae have been prescribed together for centuries in traditional Chinese medicine for edema, fluid accumulation, and ascites, appearing in classical formulations such as Da Wu Yin Wan. Yet the pairing belongs to the classic eighteen incompatible medicaments, a traditional prohibition rooted in severe organ toxicity when the herbs are prepared conventionally. Modern investigations had hinted that the combination could mitigate ascites associated with hepatocellular carcinoma, but how to harness its synergy while avoiding organ damage remained unresolved. The new study resolved this tension through supramolecular engineering rather than simple co-administration.

To build the hydrogel, the researchers extracted an ethyl acetate fraction from Euphorbia pekinensis using reflux extraction with 95 percent ethanol, then combined it with glycyrrhizic acid in a one-to-one ratio and co-decocted the mixture. Heating to 65 degrees Celsius produced a sol, and on cooling to room temperature the solution gelled within minutes. Electron microscopy revealed why the combination behaves so differently from either component alone: whereas the Euphorbia fraction forms heterogeneous, irregular particles, the co-decocted material self-assembles into a homogeneous gel of uniformly distributed spherical nanoparticles roughly 200 nanometers in diameter. Rheological testing confirmed a stable gel state at low shear strain, with shear-thinning behavior that allows the material to be extruded cleanly through a syringe, a property essential for clinical injectability.

Spectroscopic and computational analyses illuminated the assembly mechanism at the molecular level. High-performance liquid chromatography showed that glycyrrhizic acid boosted the solubility of euphol, a marker compound of the herb, from a chromatographic peak area of 145.9 in isolation to 2530.3 in the combined preparation. Ultraviolet-visible and infrared spectroscopy located the binding interaction at hydroxyl groups, whose stretching vibrations shifted to lower wavenumbers in the assembly, and two-dimensional nuclear magnetic resonance experiments revealed close spatial contact between the hydroxyl group of euphol and the hydrophilic glucuronic acid end of glycyrrhizic acid. Molecular dynamics simulations depicted randomly dispersed molecules gradually forming binary aggregates through hydrogen bonding, which then intercalate and intertwine into an ordered supramolecular network. In short, the weak, noncovalent bonds between the two herbal molecules create a genuinely new state of matter, not a mere mixture.

The practical payoff of this architecture became apparent in live animals. Using fluorescent imaging in mice bearing ascites tumors, the team showed that the hydrogel remained concentrated in the abdominal cavity for at least 24 hours after intraperitoneal injection, whereas free fluorescent dye cleared rapidly. Enhanced retention was also observed in the liver and kidneys, with negligible accumulation in the heart, lungs, or spleen. This localized biodistribution maximizes drug exposure at the disease site while minimizing off-target toxicity, and it reduces the frequency of administration required, a meaningful advantage for patients undergoing repeated peritoneal procedures.

Therapeutic performance matched the elegant delivery design. In a subcutaneous xenograft model of H22 liver cancer, the hydrogel at 18.75 milligrams per kilogram per day achieved a tumor growth inhibition rate of 68.63 percent, approaching the 74.98 percent produced by cyclophosphamide at 20 milligrams per kilogram. Critically, the toxicology diverged sharply: cyclophosphamide significantly shrank the spleen, evidence of immune organ damage, while the hydrogel left liver, kidney, and spleen indices unchanged and produced no pathological abnormalities on histological staining. In a malignant ascites model established by intraperitoneal injection of H22 cells, hydrogel-treated mice showed markedly reduced abdominal circumference and slower weight gain driven by ascites accumulation, and organ indices that had fallen in untreated diseased animals were largely restored. The assembly appears to tame the herb’s inherent toxicity through an aggregation and assembly retention effect that concentrates the supramolecular complex at the tumor while sparing healthy tissue.

Transcriptomic and metabolomic profiling converged on a unified mechanism. RNA sequencing of treated tumors identified thousands of differentially expressed genes, with pathway enrichment pointing decisively to the PI3K-AKT and mTOR signaling cascades alongside apoptosis, hypoxia-inducible factor, and immune checkpoint pathways. Serum metabolomics revealed 119 key metabolites altered by treatment, with glycerophospholipid metabolism and choline metabolism in cancer emerging as the most significant enriched pathways, suggesting the hydrogel impairs choline utilization and phospholipid recycling and forces tumor cells toward mitochondrial fatty acid oxidation to sustain membrane homeostasis. A combined analysis of gene and metabolite shifts, applied for the first time in this ascites context, pointed to choline kinase alpha inhibition as the pivotal event.

Laboratory validation sealed the case. The hydrogel inhibited H22 cell growth in a concentration-dependent manner, elevated intracellular reactive oxygen species, collapsed mitochondrial membrane potential, and triggered apoptosis, the programmed cell death cascade that ultimately dismantles tumor cells. Choline kinase alpha activity fell dose-dependently with hydrogel treatment, and the known choline kinase inhibitor MN58b cooperated with the hydrogel at higher concentrations to amplify apoptosis. Western blotting and immunohistochemistry confirmed that treatment reduced the expression of choline kinase alpha and the phosphorylated, active forms of PI3K, AKT, and mTOR in both cells and tumor tissue. Together, the results establish the hydrogel as a choline kinase alpha inhibitor that suppresses the PI3K/AKT/mTOR axis to combat malignant ascites. Because the formulation is carrier-free, self-assembled from inexpensive natural molecules, and produced by simple co-decoction, the researchers argue it offers a practical blueprint for nature-derived, ascites-targeted precision therapeutics, though human trials will be needed to confirm whether the remarkable preclinical safety and efficacy translate to patients.

Subject of Research: A self-assembled herbal hydrogel that inhibits choline kinase alpha and the PI3K/AKT/mTOR pathway to treat hepatocellular carcinoma and malignant ascites.

Article Title: Injectable multi-component hydrogel as an inhibitor of choline kinase α achieved the treatment of malignant ascites by inhibiting PI3K/AKT/mTOR signaling pathway

Article References: Yang, Y., Qi, J., Zhu, Z., Wu, M., Zhao, Y., Wang, M., Lang, Y., Gu, Y., Liu, Y., & Cai, M. (2026). Injectable multi-component hydrogel as an inhibitor of choline kinase α achieved the treatment of malignant ascites by inhibiting PI3K/AKT/mTOR signaling pathway. Journal of Advanced Research, 87, 1105-1120. https://doi.org/10.1016/j.jare.2026.01.001

Image Credits: AI Generated

DOI: 10.1016/j.jare.2026.01.001

Keywords: hepatocellular carcinoma, malignant ascites, hydrogel, choline kinase alpha, PI3K/AKT/mTOR pathway, drug delivery, self-assembly, natural products, glycyrrhizic acid, Euphorbia pekinensis, metabolomics, nanomedicine

Malignant ascites, the pathological accumulation of fluid within the peritoneal cavity driven by cancer involving the peritoneal membrane, increased vascular permeability, or lymphatic blockage, accounts for roughly 10 to 15 percent of all ascites cases and carries a poor prognosis. The condition produces a cascade of debilitating symptoms: abdominal fullness and bloating, pain, nausea, difficulty breathing, reduced mobility, and loss of appetite, all of which erode quality of life at a stage when patients and their families have limited time together. Unlike ascites caused by cirrhosis or heart failure, dietary modification and diuretics tend to be ineffective in the malignant form, leaving fluid evacuation as the mainstay of palliative treatment.

Repeated large-volume paracentesis addresses the symptom but never the underlying cause, so the procedure must be performed regularly, at considerable cost to both patients and health systems and with a cumulative risk of procedural complications. Tunneled indwelling peritoneal catheters, or IPCs, have emerged as an alternative that allows drainage at home. The United Kingdom’s National Institute for Health and Care Excellence approved first-generation devices as cost-effective in 2012 and reaffirmed that judgment in 2022, but many supporting studies involved small patient numbers, and clear criteria identifying which patients are most likely to benefit have been lacking.

The new analysis, led by Krasen Zdravkov Ivanov of University Hospital Saint Ekaterina in Sofia, Bulgaria, together with Hans-Ulrich Laasch of the University of Manchester, examined a large single-center cohort treated with a second-generation device. Patients were eligible if their ascites required at least two drainage procedures per month. Exclusion criteria included active peritoneal infection, deranged clotting with an INR above 1.8 or platelet counts below 50,000 per microliter, loculated ascites, an ECOG performance status of 4 with estimated survival under three weeks, and known allergy to catheter components. Every patient underwent history and physical examination, laboratory testing, and abdominal ultrasound at least 48 hours before implantation.

The technical details of the procedure are central to its success. The Aspira catheter is a 15.5-French, 72-centimeter fenestrated silicone tube with 50 drainage holes on its intraperitoneal end. A single experienced interventionalist performed all insertions using an antegrade tunneling technique under sterile conditions, with local anesthesia and perioperative intravenous ceftriaxone. After ultrasonography identified an implantation site away from scars, tumor masses, bowel, and other organs, typically in the iliac fossa, a subcutaneous tunnel of roughly five to eight centimeters was fashioned, the abdominal cavity was punctured under ultrasound guidance, and a peel-away sheath fitted with a leakage-preventing valve was placed over a guidewire. Correct positioning of the catheter tip in the pelvis was confirmed with ultrasound or X-ray. Technical success was achieved in all 124 patients without exception.

The cohort, with a mean age of 60.6 years and a strong female majority at 67.7 percent, reflected the typical epidemiology of malignant ascites: ovarian cancer was the most common primary malignancy at 19.4 percent, followed by breast cancer at 18.5 percent and colon cancer at 14.5 percent. Adenocarcinoma accounted for more than three-quarters of tumor types, peritoneal carcinomatosis was the leading mechanism at 42.7 percent, and the fluid was predominantly an exudate. Nearly three-quarters of patients were actively receiving chemotherapy, radiotherapy, or immunotherapy, while the remainder were on supportive or palliative care.

Symptom outcomes were striking. Using the Edmonton Symptom Assessment System modified for ascites, researchers found statistically significant improvement in every symptom measured at 30 days, including pain, general weakness, nausea, depression, anxiety, drowsiness, appetite, sense of well-being, shortness of breath, abdominal bloating, and impaired mobility, all with p-values below 0.001. The largest average changes were in abdominal bloating, which improved by 8.1 points on the 10-point scale, impaired mobility by 6.3 points, and pain by 6.0 points. Significant improvements in fluid-volume symptoms such as shortness of breath and bloating persisted at 90 days, although anxiety, appetite, well-being, and mobility gains were no longer statistically significant at that point, a pattern the authors attribute partly to cancer progression and the side effects of ongoing anticancer therapy. The mean number of hospital visits fell by 45.4 percent between the 30-day and 90-day periods, from 1.1 to 0.6 per interval. The mean duration of catheter use was 103.3 days.

Safety results were also reassuring. Twenty-six patients, or 21.0 percent, experienced catheter-related complications, but most were minor and easily managed. These included cellulitis in seven patients treated successfully with antibiotics, ascites leakage at the implantation site within 48 hours in five patients corrected with sutures, valve defects in two patients whose valves were replaced without removing the catheter, and subcutaneous hematomas in two patients. Ten complications, or 8.1 percent, were classified as moderate because they required catheter removal: one device obstruction from adjacent tumor overgrowth, one dislocation, and eight cases of secondary bacterial peritonitis. All patients recovered after systemic antibiotics or device replacement, and no infection-related deaths occurred. Notably, patients with serous and fibrinous ascites fluid experienced complications more frequently, an observation that may help guide aftercare intensity.

Beyond the numbers, the study’s practical contribution is a treatment algorithm to help clinicians select candidates most likely to benefit, an area where formal guidelines have been notably absent. The authors emphasize that adequate control of ascites symptoms can determine whether a patient is well enough to continue treatment for the underlying malignancy, and that reliable home drainage helps patients return home sooner and spend quality time with loved ones. They also highlight device-specific advantages, including a valve system that nearly eliminates fluid spillage during implantation, an infection control benefit as well as a slip hazard reduction, the option of retrograde tunneling to improve cuff fixation, and repairability that avoids removal and reinsertion in cases of accidental damage.

The authors acknowledge the limitations of a single-center, retrospective, non-comparative design, and note that the number of patients with quality-of-life data declined at 90 days. Nevertheless, they conclude that tunneled indwelling peritoneal catheters combine a high rate of technical success, durable clinical benefit, and manageable complications, offering physicians an effective, cost-conscious approach to caring for one of the most vulnerable populations in oncology.

Subject of Research: Clinical outcomes of tunneled indwelling peritoneal catheters for malignant ascites palliation

Article Title: Clinical outcomes following insertion of second-generation (Aspira®) tunneled indwelling peritoneal catheters to treat malignant ascites

Article References: Ivanov, K. Z., & Laasch, H.-U. (2026). Clinical outcomes following insertion of second-generation (Aspira®) tunneled indwelling peritoneal catheters to treat malignant ascites. CVIR Oncology, 2(1), Article 16. https://doi.org/10.1007/s44343-026-00047-1

Image Credits: AI Generated

DOI: 10.1007/s44343-026-00047-1

Keywords: malignant ascites, peritoneal catheter, palliative care, paracentesis, oncology, interventional radiology, quality of life, catheter complications, Aspira drainage system, cancer symptoms, peritoneal carcinomatosis, Clinical