PURPOSE: To prospectively assess the safety of the PleurX catheter in the management of recurrent ascites in patients with advanced abdominal malignancy and the consequent quality of life among these patients.
MATERIALS AND METHODS: This was a multicenter, prospective study of PleurX catheters implanted between March 2004 and April 2005 for control of nonhepatic abdominal ascites associated with malignancy. A total of 34 subjects were included (age range, 40-81 years; mean age, 64.3 y) who underwent 440 drainage sessions. Subjects kept records of volume and frequency of ascites drainage and recorded any difficulties encountered with use of the device. Subjects assessed symptoms before device insertion and weekly for as long as 12 weeks. Serum laboratory values reflecting overall volume status were tracked.
RESULTS: All catheter insertions were successful without major procedural complications. Twenty-nine (85%) required no catheter intervention or separate therapeutic paracentesis during 12 weeks observation or until the patient's death. Three needed a total of 13 interventions to restore catheter function. Before 12 weeks, 26 subjects died. Five discontinued catheter use as a result of catheter function despite the presence of ascites. Ascites resolved in five patients. Bloating and abdominal discomfort were significantly reduced at 2 and 8 weeks (P < .05). At weekly follow-up, 83%-100% of subjects reported their ascites to be well controlled. There were no significant changes in blood chemistry results between baseline and 12 weeks. One case of peritonitis at 10 weeks resolved with antibiotic treatment.
CONCLUSIONS: In terminally ill patients, PleurX catheter use resulted in improvement of ascites-related discomfort and was associated with low rates of serious adverse clinical events and catheter failure.
We report our experience with a radiologically placed peritoneal port-catheter in palliation of malignant ascites. Port-catheters were successfully placed under ultrasonographic and fluoroscopic guidance in seven patients (five women, two men) who had symptomatic malignant ascites. The long-term primary patency rate was 100%. The mean duration of catheter function was 148 days. Seven patients had a total of 1040 port-days. Two patients received intraperitoneal chemotherapy via the port-catheter. There were no procedure-related mortality and major complications. Minor complications such as ascitic fluid leakage from the peritoneal entry site, migration of the catheter tip to the right upper quadrant, and reversal of the port reservoir occurred in four patients. None of these complications affected the drainage and required port explantation. In patients with symptomatic malignant ascites, a peritoneal port-catheter can provide palliation and eliminate multiple hospital visits for repeated paracentesis with high patency and low complication rates.
BACKGROUND: Malignant ascites is a manifestation of end stage events in a variety of cancers and associated with a poor prognosis. We evaluated the pattern of cancers causing malignant ascites and factors affecting survival.
PATIENTS AND METHODS: Patients coded with the International Classification of Diseases-9 coding system for malignant ascites over a 2-year period were reviewed. The clinicopathological data and patients' survival were compared among cancer groups.
RESULTS: There were 209 patients (140 females and 69 males), median age being 67 (30-98) years. The commonest cancer was ovarian followed by gastrointestinal (GI) cancers. Fifty-eight per cent of the patients had symptoms related to the ascites. Liver metastases were significantly commoner in the GI cancers (P = 0.0001). Fifty-four per cent of our patients presented with ascites at the initial diagnosis of their cancer. Paracentesis was given to 112, diuretics to 70 and chemotherapy to 103 patients. The median survival following diagnosis of ascites was 5.7 months. Ovarian cancer favoured longer survival while low serum albumin, low serum protein and liver metastases adversely affected survival. The independent prognostic factors for survival were cancer type, liver metastases and serum albumin.
CONCLUSION: The identified independent prognostic factors should be used to select patients for multimodality therapy for adequate palliation.
BACKGROUND: Malignant ascites is a common complication of advanced or recurrent ovarian cancer and multiple other neoplasms, causing significant patient morbidity as well as a large treatment obstacle for the physician. While multiple methods of peritoneal drainage have been reported, including large volume therapeutic paracentesis, peritoneogastric, peritoneourinary, and peritoneovenous shunting procedures, peritoneal port-a-catheter placement and hemodialysis catheter drainage, all have their associated limitations and adverse effects.
CASE: We report off label semi-permanent catheter placement in a patient for treatment of malignant ascites that functioned effectively with drainage of 2 l daily for approximately 18 months, the longest reported use in the literature.
CONCLUSION: Long-term semi-permanent catheter use is a potentially valuable modality for the palliation of malignant ascites.
ANTECEDENTES: Para explorar la asociación entre el volumen de hidratación y los síntomas durante las últimas 3 semanas de vida en pacientes terminales de cáncer.
PACIENTES Y MÉTODOS: Se realizó un estudio multicéntrico, prospectivo, observacional de 226 pacientes consecutivos con enfermedades terminales con tumores abdominales. Primaria los médicos y enfermeras responsables de evaluar la gravedad de la deshidratación membranosa (puntuación de deshidratación calculada a partir de tres hallazgos físicos), edema periférico (puntuación edema calculado a partir de siete hallazgos físicos), ascitis y derrame pleural (clasificado como físicamente indetectable a los síntomas), la secreción bronquial, hiperactividad delirio (Delirio del Memorial Escala de Evaluación), capacidad de comunicación (la Escala de Comunicación de capacidad), agitación (Escala de Agitación de socorro), mioclonías y úlceras por decúbito.
RESULTADOS: Los pacientes fueron clasificados en dos grupos: el grupo de hidratación (n = 59) que recibieron 1 litro o más de hidratación artificial por día, 1 y 3 semanas antes de la muerte, y el grupo sin hidratación (n = 167). El porcentaje de pacientes con deterioro en la puntuación de la deshidratación en las últimas 3 semanas fue significativamente mayor en el grupo sin hidratación que el grupo de hidratación (35% versus 14%, p = 0,002), mientras que los porcentajes de pacientes con puntuaciones de los síntomas de edema, ascitis y derrame pleural aumento fue significativamente mayor en el grupo de hidratación que el grupo sin hidratación (44% frente al 29%, P = 0,039 y el 29% frente a 8,4%, P <0,001, 15% frente al 5,4%, P = 0,016; respectivamente, ). Después de controlar múltiples covariables y los ajustes de tratamiento, la asociación entre el grupo de hidratación y deshidratación / puntuación de ascitis fue estadísticamente significativa. El análisis de subgrupos de pacientes con metástasis peritoneales identificó interacción estadísticamente significativa entre el grupo de hidratación y deshidratación / puntuación de derrame pleural. No hubo diferencias significativas en el grado de la secreción bronquial, delirio hiperactivo, capacidad de comunicación, agitación, mioclonos o úlceras por decúbito.
CONCLUSIONES: La terapia de hidratación artificial podría aliviar membranosas signos de deshidratación, pero podría empeorar el edema periférico, ascitis y derrame pleural. Se sugiere que los beneficios potenciales de la terapia de hidratación artificial debería equilibrarse con el riesgo de empeoramiento de los síntomas de retención de líquidos. Otros estudios clínicos están muy necesaria para identificar los efectos de la terapia de hidratación artificial en el paciente el bienestar general, y un tratamiento individualizado y un estrecho seguimiento de la deshidratación y los síntomas de retención de líquidos es muy recomendable.
