Management of symptomatic ascites and post-operative lymphocysts with an easy-to-use, patient-controlled, vascular catheter

Stukan, Maciej; Leśniewski-Kmak, Krzysztof; Wróblewska, Magdalena; Dudziak, Mirosław

doi:10.1016/j.ygyno.2014.11.073

Cited by 13 publications

(14 citation statements)

References 39 publications

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“…A mean admission time of 5.5 days (range 2–14 days) was reported, and the mean drained volume during admission was 8499 mL (range 800–20700 mL), of which the mean was 2850 mL (300–4200 mL) in the first 24 h 26. The CVC could also be inserted, with local anesthesia, under ultrasound guidance, with 100% technical success, without procedure-related complications, in an outpatient department 27. In the case of CVC usage, no significant infection or insertion-related AEs were reported.…”

Section: Resultsmentioning

confidence: 99%

“…These were managed using local procedures such as additional sutures, use of a bag to collect the fluid if leakage occurred, and catheter replacement 26–28. CVCs are rather ineffective in patients with mucinous ascites 27. Patients reported alleviation of all the ascites-related symptoms after drainage by CVC compared with baseline, with abdominal swelling, anorexia, and constipation being the most significantly changed (the severity of the symptoms was assessed using a linear scale) 28.…”

Section: Resultsmentioning

confidence: 99%

“…In a series of 17 patients who underwent insertion of a peritoneal drain (published in 1990), all reported satisfaction with the drain and felt that their lifestyle was significantly improved by the device 34. Patients with permanently inserted catheters can control ascites drainage by themselves, and therefore are not confined to the area of their hospital for repeated PC 27,43…”

Section: Resultsmentioning

confidence: 99%

“…For patients with EOC, a PC to dryness can be safely performed as an outpatient, but takes 6–8 h 18. In contrast, insertion of a CVC into the abdominal cavity for ascites drainage is easy, and can be performed in an outpatient department, under local anesthesia, using a short ultrasound assessment to determine the safest place to position the catheter 27. Moreover, the CVC provides all the advantages of a permanent drain.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, chemotherapy should not be a contraindication to catheter placement 27,47. An additional advantage of TPC or PPP for ascites drainage is that intraperitoneal infusion of chemotherapy (cisplatin) or active targeted therapeutic agents (catumaxomab) is possible 8,31…”

Section: Discussionmentioning

confidence: 99%

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Drainage of malignant ascites: patient selection and perspectives

Stukan¹

2017

CMAR

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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.

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Section: Resultsmentioning

confidence: 99%