Draining malignant ascites: perspectives of tunneled peritoneal drainage catheters

Abstract

Purpose Recurrent malignant ascites, and the resulting need for repeated drainage are frequent problems in oncology. A source of discomfort for the patient, unscheduled hospitalizations and emergency room visits, recurrent ascites generate multiple constraints for patients and complications in their care pathway. Repeated ascites paracenteses become all the more restrictive when patients no longer receive treatment requiring hospitalization and as their general condition deteriorates. In this context, our cancer center decided to offer patients the option of a peritoneal drain, enabling fluid removal at home. These devices have been available in our establishment since 2017, in collaboration with the interventional radiology department using an ultrasound-guided approach. Methods The primary aim of this study is to evaluate the efficacy, safety and complications associated with placing a tunneled catheter to drain recurrent malignant ascites. Its secondary objective is to evaluate patients’ care pathways following catheter placement. A retrospective approach included 54 patients with refractory ascites who were offered a tunneled ascites drainage catheter between January 1, 2017, and December 31, 2021. Results 56 patients were included in this study; 46 underwent the implantation of a peritoneal drain. The average duration of use for this drain was 58 days. Eight patients experienced complications following the placement of this device, with 2 requiring hospitalization. One of the complications led to the death of a patient. Our study did not identify factors predisposing the occurrence of complications. The implementation of this device facilitated the return home for 80.4% of our population, increasing the likelihood of home deaths compared to the general population of cancer patients. Conclusion Results of this preliminary study should lead to a larger-scale prospective study, as well as to the development of professional recommendations for placing a peritoneal drain in patients with refractory malignant ascites.