Management of drainage for malignant ascites in gynaecological cancer

Abstract

Background Most patients with advanced ovarian cancer and some patients with advanced endometrial cancer need repeated drainage for malignant ascites. Guidelines to advise those involved in the drainage of ascites are usually produced locally and are generally not evidence-based but mainly based on clinicians’ anecdotal evidence and experience. To discover whether there are ways of managing drains that have been demonstrated to improve the efficacy and quality of the procedure is key in making recommendations which could improve the quality of life (QOL) for women at this critical period of their lives. Objectives To evaluate the benefit and harms of different practices in the management of drains for malignant ascites in the care of women with advanced or recurrent gynaecological cancer. The review aimed to evaluate the evidence regarding the following questions; How long should the drain stay in place? Should the volume of fluid drained be replaced intravenously? Should the drain be clamped to regulate the drainage of fluid? Should any particular vital observations be regularly recorded? Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) Issue 1, 2009, Cochrane Gynaecological Cancer Group Trials Register, MEDLINE1950 to February Week 3 2009, Embase 1980 to 2009 Week 8 2009. We also searched registers of clinical trials, abstracts of scientific meetings, reference lists of review articles and contacted experts in the field. Selection criteria We searched for randomised controlled trials (RCTs), quasi-RCTs and non-randomised studies that compared a range of interventions for management of multiple paracentesis in women with malignant ascites who had a confirmed histological diagnosis of gynaecological cancer. Data collection and analysis Two review authors independently assessed whether potentially relevant studies met the inclusion criteria. No trials were found and therefore no data were analysed. Main results The search strategy identified 1664 unique references of which 1646 were excluded on the basis of title and abstract. The remaining 18 articles were retrieved in full, but none satisfied the inclusion criteria. Authors’ conclusions Since no relevant studies were identified, we are unable to make recommendations regarding the management of drains for malignant ascites in women with gynaecological cancer. Large, multi-centre RCTs are required to evaluate the efficacy and safety of the management of ascitic drains when in situ and their impact on QOL.

Palliative long-term abdominal drains in refractory ascites due to end-stage liver disease: A case series

“…In the six months prior to LTAD insertion the median number of LVP episodes was 7 (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). Following the intervention, GI related hospital attendance reduced from a median of 9 (4-21) to 1 (0-4), however none of these attendances were for management of ascites or LVP (Table 1).…”

“…To ensure amenability for drainage, patients wait until their ascites is tense, with consequent increased symptom severity (5). RA is therefore an important determinant of reduced quality of life (QoL) in ESLD (6).…”

Health-related quality of life in ovarian cancer patients and its impact on clinical management

“…This is perhaps because paracentesis provides only temporary relief and often requires repetitive procedures over short periods of time. A recent Cochrane review attempted to search for trials examining the management of multiple paracentesis in women with malignant ascites and a diagnosis of gynecologic cancer [39]. Unfortunately, no trials were identified and thus recommendations could not be generated regarding the efficacy, safety and QOL effects of this therapy.…”

Overexpression of ARF1 is associated with cell proliferation and migration through PI3K signal pathway in ovarian cancer

“…Ovarian cancer, which is the fifth leading cause of tumorassociated mortalities in female (1,2), accounts for 4% of all cancers in women and is still the leading cause of death in gynecologic malignancies (3). Besides, among all ovarian cancers, epithelial ovarian cancer (EOC) accounts for 80-90% (4), and has the highest mortality rate of all gynecological malignancies.…”