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Background/aims: Malignant ascites is one of the poor prognostic factors for pancreatic cancer, and causes serious symptoms and treatment-related toxicity. We conducted a retrospective analysis to evaluate the efficacy of 5-fluorouracil (5-FU) plus cisplatin (FP therapy) for controlling malignant ascites in patients with advanced pancreatic cancer., Methodology: This analysis was based on 28 consecutive chemotherapy-naive advanced pancreatic cancer patients with cytologically proven malignant ascites who were treated with FP therapy from November 1991 to April 2003., Results: No patients achieved measurable tumor responses. The objective improvement of ascites was seen in 35.7% of the patients (N = 10/28, 95% confidence interval, 18.0 to 53.4%), but there was no patient with complete disappearance of ascites. The median time to disease progression and the median survival time were 1.7 months and 2.7 months, respectively. In all pretreatment variables, the presence of distant metastasis other than peritoneal dissemination was an unfavorable predictive factor for the objective improvement of ascites (Fisher's exact test: P = 0.002)., Conclusions: FP therapy was modestly effective for controlling malignant ascites but insufficient in shrinking for measurable metastatic lesions. Systemic chemotherapy for controlling malignant ascites might be worth while for palliative management in advanced pancreatic cancer patients, especially in patients without distant metastasis.