Prise en charge symptomatique de l’ascite maligne en phase palliative : place de la paracentèse et des diurétiques

Gamblin, Vincent; Silva, Arlette Da; Villet, Stéphanie; Hajbi, Farid El

doi:10.1016/j.bulcan.2015.09.002

Cited by 5 publications

(4 citation statements)

References 26 publications

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“…PC brings immediate but temporary relief in 78%–90% of cases, and implies multiple hospitalizations 2,10,17. This approach is undertaken in hospital, as a day-case or inpatient procedure 18.…”

Section: Introductionmentioning

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: Introductionmentioning

confidence: 99%

Drainage of malignant ascites: patient selection and perspectives

Stukan¹

2017

CMAR

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“…Malignant ascites is an abnormal accumulation of fluid in the peritoneal cavity as a consequence of cancer, which is very common in ovarian, endometrial, breast, colon, gastric, liver, and pancreatic carcinomas, particularly in the advanced stages. Intractable malignant ascites usually have poor prognosis with a life expectancy ranging from 1 to 4 months [ 20 , 21 ]. Although various alternative therapies, including diuretic medicine, have been employed, the evidence regarding their effects on malignant ascites has yet to be fully elucidated [ 22 , 23 ].…”

Section: Resultsmentioning

confidence: 99%

Effect of Glycyrrhiza on the Diuretic Function of Euphorbia kansui: An Ascites Mouse Model

Lin

Zhang

Shang

et al. 2016

Evidence-Based Complementary and Alternative Medicine

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We investigated the therapeutic role of the herbal combination Euphorbia kansui (GS) and Glycyrrhiza (GC) in ascites during hepatocellular carcinoma (HCC). The AVPR2 and AQP2 expression in kidney tissues of ascites mice in different groups was determined by immunohistochemistry, Western blot, and real-time PCR analyses. When the dose of GS was less than 0.70 g/kg at a ratio of GC : GS not exceeding 0.4 : 1, the combination of GS and GC exhibited synergistic effects on HCC ascites and significantly elevated the expression levels of AVPR2 and AQP2 (all P < 0.05). On the contrary, when GS ≥ 0.93 g/kg and GC ≥ 1.03 g/kg with the GC-to-GS ratio exceeding 1.11 : 1, the combination of GS and GC displayed antagonistic effects on HCC ascites and dramatically reduced the expression levels of AVPR2 and AQP2 (all P < 0.05). Furthermore, the administration of herbal pair GS and GC at different ratios did not exacerbate the pathological changes in liver and kidney tissues of HCC ascites mice. The different combinations of GS and GC exerted synergistic or antagonistic effects on HCC ascites, partially by regulating the expression of AVPR2 and AQP2.

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“…Diuretic therapy in the management of the ascites is rarely performed (61% of all ascites) and is less effective than paracentesis (45%) (11). Unlike benign ascites (liver cirrhosis and congestive heart failure), malignant ascites respond poorly to the therapy including fluid and salt restrictions and diuretics that may cause complications such as a decrease in volume, electrolytic imbalance, and renal dysfunction.…”

Section: Therapeutic Approach In Ovarian Carcinoma Patientsmentioning

confidence: 99%

Treatment Modalities for the Management of Ascites in Ovarian Cancer Pa Tients

Živadinović¹,

Krtinić²,

Živadinović³

et al. 2018

AMM

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Ascites involve the presence of a higher amount of free fluid accumulated in the abdominal cavity. Pathophysiology of malignant ascites is multifactorial and represents a combination of two basic pathogenetic mechanisms, increased vascular permeability and obstruction of lymphatic drainage. Ascites is the most common symptom of patients with ovarian cancer reporting to a doctor. The primary therapeutic option in the treatment of ovarian cancer is cytoreductive surgery and platinum therapy. Intraperitoneal chemotherapy aims to increase the concentration of the drug at the target site by avoiding a resorptive toxic effect. Of the surgical methods used in palliative treatment of ascites, the creation of peritoneal shunts should be mentioned. A modern innovative approach in the treatment of ascites involves the use of specific monoclonal antibodies that focus on one of the basic etiological factors of ascites-neoangiogenesis. In treatment, a multidisciplinary approach is needed not only for gynecologists but also for anaesthesiologists, gastroenterologists, surgeons, palliative doctors, and a medical oncologist.

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Prise en charge symptomatique de l’ascite maligne en phase palliative : place de la paracentèse et des diurétiques

Cited by 5 publications

References 26 publications

Drainage of malignant ascites: patient selection and perspectives

Drainage of malignant ascites: patient selection and perspectives

Effect of Glycyrrhiza on the Diuretic Function of Euphorbia kansui: An Ascites Mouse Model

Treatment Modalities for the Management of Ascites in Ovarian Cancer Pa Tients

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