Drainage of malignant ascites: patient selection and perspectives

Abstract

Malignant ascites (MA) is a sign of advanced cancer and poor prognosis. MA can result in impairment in quality of life (QOL) and significant symptoms. As a supportive treatment, ascites can be drained by paracentesis (PC), percutaneously implanted catheters (tunneled, untunneled, central venous catheters), or peritoneal ports, or peritoneovenous shunts. The aim of this study was to evaluate the effectiveness, safety, and patient-reported outcomes (PRO) of different drainage methods for the management of MA. A systematic review of the literature was performed, and 32 original articles met the inclusion criteria. Patients selected for permanent drain insertion demonstrated symptoms related to MA and had undergone repeated PC. The primary focus of the reviewed articles was procedural safety issues. The rate of technical success of drainage device installation was 100%. Most patients experienced improvements in symptom control after ascites drainage. When analyzed together, 19.7% (255/1297) of patients experienced any complication and 6.2% (81/1297) experienced serious adverse events during MA drainage. Complications were reported for every drainage method; however, the least occurred after PC or central venous catheter, while the most serious occurred after peritoneovenous shunts. Adverse events were as follows: catheter obstruction: 4.4%, infection: 4.1%, leakage: 3.5%, catheter dislodgment: 2.3%, hypotension: 0.6%, injuries during device insertion: 0.6%, renal impairment: 0.5%, electrolyte imbalance: 0.2%, other: 3.6%. PRO and QOL endpoints were available for 12 studies. When PRO were measured using an interview, a significant improvement in symptom control and QOL was reported in almost all patients. Once standardized questionnaires were used, improvements in symptomatic scores and role functioning were observed. Deterioration was observed in cognitive and emotional subscales. MA drainage is a safe and effective method to control symptoms associated with ascites, and should be perceived as a supportive care, that can be applied for those who need it at any time of their cancer trajectory. Patient selection should be performed using a thorough assessment of symptoms and QOL, and should not be delayed.

Use of indwelling pleural/peritoneal catheter in the management of malignant ascites: a retrospective study of 48 patients

“…However, our databases covered all eligible patients in the participating centres which would minimise selection bias. The baseline demographics of this case series were similar to previously published case series, showing similar age range, female predominance and range of malignancies . Second, the participating centres all had pleural specialists with training and experience in IPC management and a dedicated aftercare support service.…”

Prognostic Nutritional Index Predicts Treatment Outcomes following Palliative Surgery for Colorectal Adenocarcinoma

“…Low nutritional status and a past history of heart, liver, and renal failure in the patient can also contribute to the presence of ascites. Therefore, the causes of ascites in patients with advanced cancer could be attributed to a number of etiological factors 11) . This suggests that a single cause of ascites does not have significant prognostic value, as multiple factors including low nutrition, cancer cachexia, and organ failure influence the prognosis.…”

Achieving sequential therapy in advanced gastric cancer: the importance of appropriate patient management for the elderly and/or those with ascites

“…In terms of supportive treatment, ascites can be drained by paracentesis, percutaneously implanted catheters or peritoneal ports, and peritoneovenous shunts [75]. A systematic review of drainage techniques reported that symptom control was achieved in approximately 97% of patients after ascites drainage and, importantly, PROs and QoL were also improved after drainage [75]. However, drainage of ascites is associated with fatigue and hemodynamic instability [76], thought to be related to the loss of proteins in the drainage fluid.…”