Pancreatic Cancer & Bacterial Peritonitis
Ascites is commonly associated with various malignancies, but pancreatic cancer presents a unique challenge due to its proximity to the portal system, which predisposes it to both portal hypertensive and malignant ascites. This results in distinct characteristics of pancreatic cancer-associated ascites, including the development of bacterial peritonitis, similar to that seen in cirrhotic ascites.
Currently, there is no established diagnostic criteria for bacterial peritonitis in the context of pancreatic cancer-associated ascites. Using the same criteria applied to cirrhotic ascites often leads to a high rate of false positives, contributing to suboptimal patient outcomes.
In this study, we explored the fundamental characteristics of pancreatic cancer-associated ascites and propose an improved diagnostic approach for bacterial peritonitis, tailored specifically for pancreatic cancer patients.
We classified pancreatic cancer-associated ascites by its origin as above, and found that malignant ascites (peritoneal carcinomatosis, PC) and portal hypertensive ascites contributes similarly (30-40%) to the development of pancreatic cancer-associated ascites.
Ascites profile exhibited higher leukocyte and polymorphonuclear (PMN) cell count in the PC-dominant or Mixed ascites.
We developed modified diagnostic criteria for bacterial peritonitis in pancreatic cancer-associated ascites, prioritizing maximum specificity while ensuring 100% sensitivity in the derivation cohort. The proposed criteria are: PMN cell proportion >35% with counts >250/mm3.
LASSO regression and Bootstrapping was implemented in the derivation process.
The study manuscript is currently under peer review.
An e-poster was presented at the International Conference of the Korean Pancreatobiliary Association 2023-2024, Seoul, on April 21-22, 2023. and on April 4-5, 2024.
