Indwelling Catheters for the Management of Refractory Malignant Ascites: A Systematic Literature Overview and Retrospective Chart Review

Abstract

The safety and efficacy of indwelling intraperitoneal (IP) catheters for the management of refractory malignant ascites is unclear. A systematic literature overview and retrospective chart review of patients with malignant refractory ascites who underwent indwelling IP catheter placement was performed. Standardized literature abstraction and chart review templates were used to ensure that consistent information was collected. Fifteen publications met literature search criteria, representing 221 patients. Tenckhoff (Quinton Instrument Company, Seattle, WA, USA), Pleurex (Denver Biomedical Inc., Golden, CO, USA), and peritoneal catheters were used, along with IP ports. A median 5.9% of cases (range: 2.5%-34%) had documented peritonitis. In the literature, untunneled catheters were most commonly associated with infections. Our chart review added 19 cases from two academic institutions to this literature (median age: 60 years [range: 31-85]; females: 17 [89%]; gynecological malignancies: 14 [73%]). Palliative management before catheter placement included diuretics (n=4 [21%]) and multiple paracenteses (n=11 [58%] had two or more taps [range: 2-8]). Median time from diagnosis to catheter placement was 25 months (range: 1-77). Interventions were: French pigtail catheters (n=16 [84%]), Tenckhoff catheter (n=1 [5%]), and Port-A-Caths (Smith Medical MD, St. Paul, MN, USA) (n=2; 11%). Four (21%) catheters were tunneled. Prophylactic antibiotics were prescribed in six cases (32%). Two cases (11%) had documented infections, seven catheters (37%) became occluded, and two leaked (11%). The median time from catheter until death was 36 days (range: 4-660). Nine patients (47%) were admitted to hospice. In these retrospective studies, indwelling IP catheters appear to be a safe and effective palliative strategy to manage refractory malignant ascites, without overwhelming infection rates.

Pancreas Adenocarcinoma: Ascites, Clinical Manifestations, and Management Implications

“…Therefore, to minimize repeated paracenteses and frequent hospital visits, permanent drains are frequently used. 21,23,34 We observed in our cohort that 36% (n = 64) of patients underwent paracenteses only as the means of managing ascites, with 58% of this subgroup (n = 37) having 1 to 2 paracenteses, and only 14% (n = 9) having ≥ 3 paracenteses. Nearly two-thirds of the cohort required a permanent catheter (n = 116; 64% of total analyzed cohort) to obtain palliation, and we observed that 42% (n = 49) patients required ≥ 3 paracenteses to address ascites before a catheter was placed ( P < .001).…”

“…20 Conversely, a major risk pertaining to an indwelling catheter is the development of peritonitis, and the literature shows that the risk is higher in untunneled compared with tunneled catheter types. 21 Another type of permanent drain is a peritoneal venous shunt, 22 including the LeVeen shunt, the first prototype of its kind. 23 Nevertheless, due to its poor efficacy and risk of serious complications, including port occlusion, disseminated intravascular coagulation, and short life, it was later replaced by the Denver shunt.…”

Outcomes of Permanent Peritoneal Ports for the Management of Recurrent Malignant Ascites

“…6,7 Very few cases of peritonitis associated with peritoneal ports have been described 4,8 ; uncomplicated cellulitis has been suggested as the most common infectious complication, occurring in 18% in one series. 9 Hypotension, consistent with other series, was not significant in our study.…”

Drainage of malignant ascites: patient selection and perspectives

“…The relative inefficiency of diuretics in specific types of MA is likely because of different pathophysiologic mechanisms for fluid accumulation 14. A response to diuretics has been observed in patients with ascites secondary to massive hepatic metastases who have a serum:ascitic albumin gradient of >11 g/L 12,15…”