Tunnelled Peritoneal Catheter for Malignant Ascites—An Open-Label, Prospective, Observational Trial

Abstract

Treatment of recurrent malignant ascites in cancer patients is a challenge. Evidence based guidelines regarding the best treatment strategy are lacking. The aim of this prospective study was to investigate the safety and efficacy of a tunnelled peritoneal catheter (PleurX) in cancer patients with symptomatic ascites. Patients with symptomatic, diuretics-refractory ascites and indication for the implantation of a tunnelled peritoneal PleurX catheter were prospectively enrolled between August 2018 and July 2020. The number of catheter days, complications, amount of drained ascites and ascites-associated symptoms and hospitalization rate pre- and post-PleurX insertion were analysed. 51 Patients (64.7% male) were prospectively enrolled. The mean age was 66.6 (±7.9) years. The most common cause of ascites was pancreatic adenocarcinoma (n = 10) followed by cholangiocellular carcinoma (n = 9) and hepatocellular carcinoma (n = 8). The technical success rate of PleurX implantation was 100%. The mean volume of weakly drained ascites was 5.44l (±4.08). Major complications included cellulitis (n = 2), peritonitis and drainage dislocation (each n = 1). The mean catheter days per patient was 59.8 (±107.4) (Min 4, Max 668). Abdominal discomfort, impaired mobility, dyspnoea, fatigue, nausea and vomiting were significantly reduced 30 days after PleurX insertion (p < 0.05). Moreover, hospitalization rate was significantly reduced (p < 0.001; 27.08% of days preimplantation vs. 11.27% postimplantation). We conclude that implantation of a tunnelled ascites catheter is a safe and effective method for the treatment of refractory ascites in cancer patients with advanced disease. Serious complications are rare. Burdensome ascites-associated symptoms and hospitalization rates can be significantly reduced over a longer period of time.

Draining malignant ascites: perspectives of tunneled peritoneal drainage catheters

“…In our study, the average duration of use was 57 days, ranging from 1 to 396 days. The literature reports great variation on this level, ranging from 23 days [10] to 113 days [7], directly linked to patient survival, since most patients are still wearing the device at time of death [6,11]. Furthermore, to date, there are no recommendations as to when the device should be inserted.…”

“…Nevertheless, our team's close links with homecare coordination along with the assistance provided in managing complications, minimized the possibility of missing data. Petzold et al included 51 patients in a study between 2018 and 2020 and showed that almost half the patients (n = 23) experienced complications, mainly infectious, despite administration of antibiotic prophylaxis with Ceftriaxone on implantation [11].…”

Engineered Apoptosis-Bioinspired Nanoparticles Initiate Immune Cascade for Cancer Immunotherapy of Malignant Ascites

“…1 Owing to the highly aggressive and infiltrative biological properties of liver cancer, it is virtually impossible to cure malignant peritoneal effusion. 2,3 Malignant ascites (MA) caused by hepatocellular carcinoma (HCC) are an accumulation of excess fluid within the abdominal cavity related to critical clinical difficulties. 4,5 As one of the advanced complications of HCC, it is thus often accompanied by seriously damaged bodily functions of cancer patients.…”

“…Liver cancer, as one of the most invasive and high incidence primary malignant cancers of the digestive system, has high morbidity and perishing clinical outcome . Owing to the highly aggressive and infiltrative biological properties of liver cancer, it is virtually impossible to cure malignant peritoneal effusion. , Malignant ascites (MA) caused by hepatocellular carcinoma (HCC) are an accumulation of excess fluid within the abdominal cavity related to critical clinical difficulties. , As one of the advanced complications of HCC, it is thus often accompanied by seriously damaged bodily functions of cancer patients . However, insufficient tumor targeting and the existence of the immunosuppressive microenvironment impeded chemotherapy efficacy, and MA patients tend to have poor chemotherapy response. , Thus, developing a new intraperitoneal strategy that effectively converts the immune cold into pro-inflammatory malignant peritoneal effusion is imperative to improve cancer immunotherapy …”

Malignancy-related ascites in palliative care units: prognostic factor analysis

“…The implantation of a peritoneal catheter is considered for patients requiring repeated paracentesis. Although this reduces the need for repeat punctures, it can cause adverse events such as cellulitis and peritonitis, and costs more than paracentesis 9. Additionally, a percutaneous peritoneovenous (Denver) shunt is an optional treatment for patients with MA; however, there is a risk of severe adverse events, including infection, disseminated intravascular coagulation and volume overload 10 11.…”