Peritoneal catheter for continuous drainage of ascites in advanced cancer patients

Mercadante, Sebastiano; Intravaia, Giuseppe; Ferrera, Patrizia; Villari, Patrizia; David, Fabrizio

doi:10.1007/s00520-008-0453-x

Cited by 32 publications

(33 citation statements)

References 10 publications

(14 reference statements)

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“…Insertion was technically successful in all patients, but one who required a second attempt. 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.…”

Section: Resultsmentioning

confidence: 99%

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%

Drainage of malignant ascites: patient selection and perspectives

Stukan¹

2017

CMAR

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“…35 A Denver shunt was employed in a solitary patient with refractory ascites where Tenckhoff catheter placement was not technically feasible. In rare situations, a second catheter was placed when there was ascitic fluid translocation to the pleural compartment in 4% (n = 8) of patients.…”

Section: Discussionmentioning

confidence: 99%

Pancreas Adenocarcinoma: Ascites, Clinical Manifestations, and Management Implications

Hicks

Chou

Capanu

et al. 2016

Clinical Colorectal Cancer

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This was a cohort analysis evaluating patients with pancreatic adenocarcinoma who presented with or developed ascites. Among the 180 patients analyzed, the use of serial paracenteses and indwelling catheters is a common practice to effect symptom palliation. The complication rate was higher in patients with indwelling catheters. Analyzing ascitic fluid and calculating the serum ascites albumin gradient can help attribute the etiology of the ascites and potentially identify which patients may benefit from diuretics or other intervention. Background Ascites develops in a subset of patients with pancreatic adenocarcinoma (PAC) at presentation or as the disease advances. Limited data exist on the prognostic importance of malignant ascites in PAC. Our hypothesis is that this information will provide an understanding of the natural history and facilitate management decisions. Methods We conducted a retrospective analysis of 180 patients treated at Memorial Sloan Kettering Cancer Center diagnosed between January 1, 2009 and December 31, 2014, with PAC and with ascites either at presentation or that developed during the disease course. Results For the 180 patients, the overall survival was 15 months. The time from diagnosis to ascites presentation was 11 months, and the survival time after ascites development was 1.8 months (range, 1.6–2.3 months; 95% confidence interval). Of 62 patients (34%) who had ascitic fluid analyzed, 36 (58%) had positive cytology. Fifty-one (82%) patients had a serum ascites albumin gradient ≥ 1, and 11 (18%) had serum ascites albumin gradient < 1. Sixty-four (36%) patients had their ascites managed solely by serial paracenteses. A total of 116 patients required a catheter; of these, 108 (93%) had a Tenckhoff catheter, 4 (3%) a Pleurx catheter, 4 (3%) a pigtail catheter, and 1 (1%) a Denver catheter. Eight (7%) patients required 2 catheters to be placed, and in 6 (5%), Tenckhoff catheters had to be removed. The main observed complications were spontaneous bacterial peritonitis in 7 (11%) managed with paracenteses versus 26 (23%) who had a catheter placed, catheter malfunction in 8 (7%), and acute renal failure in 6 (3%). After ascites development, 79 (44%) patients received active anti-cancer therapy, and 101 (56%) patients were managed with supportive care alone. Conclusions In patients with PAC who presented with or developed ascites, serial paracenteses and indwelling catheters are common methods used for providing symptomatic relief. The complication rate was higher with indwelling catheters, primarily related to infection (eg, bacterial peritonitis). Overall, ascites has a significantly negative prognostic import with a short median survival.

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“…Lee et al 14 Mercadante et al 19 Presente estudio que estos conllevan. Por ejemplo, no se pudo realizar una escala tipo Likert en la valoración del control de síntomas y de mejoría posterior (con una gradación desde poca mejoría hasta mucha mejoría, por ejemplo).…”

Section: Tabla 4 Comparaciones Entre Estudiosunclassified

“…Existen en la literatura notas clínicas sobre experiencias en nuestro país. En un caso se trata de un catéter para el manejo de ascitis en un paciente con cirrosis de etiología enólica18 , y en el otro artículo se comenta el caso de 3 pacientes afectos de ascitis maligna6 .Por otro lado, otros estudios muestran un número mayor de pacientes, tales como los de Lee et al 14 y Mercadante et al19 , que presentan unas muestras de 38 y 40 pacientes respectivamente. Posteriormente al artículo de Mercadante et al, apareció una revisión en la que se incluyeron 15 publicaciones, con un total de 221 pacientes; a destacar que en este último artículo todavía no aparece el trabajo de Mercadante et al Se concluye con ellos el uso de catéteres peritoneales como un buen instrumento para el manejo de la ascitis maligna, con una tasa de complicaciones aceptables.En la tabla 4 se pueden comparar los principales resultados de los estudios de Mercadante et al, Lee et al y el presente estudio.Tal y como comenta Mercadante et al, a parte de la necesidad de realizar más estudios, una de las dudas recaería en la selección del paciente.…”

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Estudio descriptivo sobre el uso de catéteres peritoneales en el manejo de la ascitis maligna

et al. 2012

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Recibido el 29 de noviembre de 2010; aceptado el 15 de diciembre de 2010 Disponible en Internet el 3 de diciembre de 2011 PALABRAS CLAVECáncer; Catéter; Ascitis maligna; Drenaje peritoneal ResumenObjetivo: Se pretende valorar la frecuencia de complicaciones con los catéteres peritoneales para el manejo de la ascitis maligna, así como la duración de los mismos. Material y métodos: Estudio descriptivo de una serie de casos. Incluidos mayores de 18 años afectos de cáncer y con colocación de catéter peritoneal entre 2003 y 2010.Recogidas variables socio-demográficas, de neoplasia, situación funcional, localización del paciente al realizar el procedimiento (ingresado/ambulatorio), duración del catéter, complicaciones y supervivencia. Resultados: Incluidos 41 pacientes, mediana de edad de 63 años ; 73,2% mujeres. El tumor más frecuente fue ovario (26,8%); 61% de los pacientes con tumores metastásicos, con una mediana en el índice de Karnofsky de 60 .Los síntomas previos fueron disnea (82,9%), disminución de movilidad (65,9%) y dolor (53,7%) En el 51% de los pacientes la técnica se realizó estando ingresado. Un 53,7% presentaron mejoría sintomática posterior.El 48,8% de los pacientes presentó una complicación, 12,2% dos complicaciones; principalmente infecciosas (14,6% de los pacientes con infección en la zona de inserción, 4,9% peritonitis, 7,3% sepsis). Tras la primera complicación se retiró el catéter en 4 ocasiones; en aquellos con 2 complicaciones en dos casos se tuvo que retirar.En la muestra recogida, en el análisis realizado no se han identificado factores asociados al desarrollo de complicaciones.La mediana de la duración del catéter fue de 24 días [2-246] y de la supervivencia global de los pacientes de 31,5 días . Conclusiones: El uso de los catéteres peritoneales para la ascitis maligna presenta complicaciones frecuentes, la mayoría leves, requiriendo retirada del mismo en pocas ocasiones.

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Peritoneal catheter for continuous drainage of ascites in advanced cancer patients

Cited by 32 publications

References 10 publications

Drainage of malignant ascites: patient selection and perspectives

Drainage of malignant ascites: patient selection and perspectives

Pancreas Adenocarcinoma: Ascites, Clinical Manifestations, and Management Implications

Estudio descriptivo sobre el uso de catéteres peritoneales en el manejo de la ascitis maligna

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