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 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.
PURPOSE: To present clinical data for a new peritoneal port for minimally invasive treatment of intractable ascites that can be used for aspiration in a patient's home.
MATERIALS AND METHODS: Twenty-eight consecutive peritoneal ports were placed in 27 patients with intractable ascites. Ascites etiology was malignancy in 22 patients, cirrhosis in three, pancreatic duct injury in one, and unknown in one. Technical and clinical success and complications were evaluated until the time of death or the end of the study.
RESULTS: All ports were inserted successfully with removal of all ascites, and all patients had immediate and complete symptom relief. Ascites was managed by periodic drainage, typically by a visiting nurse in the patient's home. The long-term clinical success rate was 96%, with 26 of 27 patients exhibiting maintained relief of symptoms until death or the end of the study. The long-term patency rate was 100% after 1,810 patient-days. Only one patient (4%) had a major complication. This was a port leak that required port exchange. Subsequently, the patient developed bacterial peritonitis.
CONCLUSION: Peritoneal ports appear to be a safe, effective, minimally invasive treatment for intractable ascites. This device allows for reliable ascites aspiration in the patient's home.
The Pleurx subcutaneous tunneled catheter is approved for repeated, long-term drainage of malignant pleural effusions; however, there is limited literature describing its use in malignant ascites. The authors compared the safety and efficacy of two percutaneous drainage methods: large volume paracentesis and Pleurx catheter placement over a 41-month period. The Pleurx catheter provided effective palliation with a complication rate similar to that for large volume paracentesis, while preventing the need for frequent trips to the hospital for repeated percutaneous drainage.
Malignant ascites in advanced cancer is usually treated by repeated paracentesis, causing both discomfort and inconvenience to patients in the terminal stages of disease. We present a case of advanced ovarian carcinoma in which intraoperative placement of a Foley's self-retaining catheter into the peritoneal cavity was used to facilitate long-term continuous drainage of malignant ascites. This is a simple, convenient and cost-effective method which decreases the need for repeated hospital admissions. The aim complication might be peritonitis, but with proper care of the device and the use of antibiotics, this was not seen in our patient.
Ascites is commonly present in women with advanced-stage ovarian cancer. No standardized protocol exists for the treatment of the patient with recurrent ovarian cancer and rapidly reaccumulating malignant ascites. Palliation of symptoms is most commonly achieved through repeated paracentesis, a procedure that potentially results in injury to intra-abdominal organs, infection, and patient discomfort. Our goal was to improve patient comfort by alleviating symptoms and reducing the need for paracentesis. The Pleurx' catheter offers a number of potential advantages over traditional treatment modalities. Clearly, larger study numbers are required to quantify the morbidity associated with the Pleurx catheter.
OBJECTIVE: We present a treatment for recurrent, symptomatic ascites in patients with malignant disease. This report summarizes our experience with percutaneous tunneled peritoneal catheters in 24 patients.
SUBJECTS AND METHODS: Of the 40 consecutive patients who presented with at least four therapeutic paracenteses in a 4-week period, 24 patients underwent the percutaneous tunneled procedure. All had malignant ascites.
RESULTS: All 24 patients had successful insertion of a permanent tunneled peritoneal drainage catheter. Eighteen were outpatients and six were inpatients. All patients were relieved of their clinical symptoms, including abdominal distention and dyspnea, and were relieved of lower extremity discomfort. The mean life span after catheter placement was 7.2 weeks. Twenty (83%) of the 24 patients were treated at home with their catheters in place. Three patients experienced minor complications from bacterial peritonitis, which responded to antibiotics. One patient had to have his catheter removed.
CONCLUSION: Percutaneous placement of specialized tunneled catheters appears to be a viable and safe technique in patients who have symptomatic ascites that require frequent therapeutic paracentesis for relief of symptoms.
Paracentesis is widely employed for palliation of symptomatic malignant ascites. In some patients, there is rapid re-accumulation of fluid necessitating frequent repeat procedures. Indwelling peritoneal drainage catheters can provide more durable symptom relief, avoiding the hazards and disadvantages of multiple repeat procedures. The goal of our study was to evaluate the technical success, complications and outcome associated with the use of these drainage catheters. We carried out a retrospective review of all patients who had indwelling catheters inserted for the management of symptomatic malignant ascites over a 4-year period. A total of 45 catheters were inserted in 38 patients. Insertion was technically successful in all patients, with immediate symptomatic relief. However, 2 cases of fatal hypotension were encountered in the first 24 h after catheter insertion (acute catheter-related mortality rate of 4.4%). These were attributed to rapid drainage of peritoneal fluid, although gastrointestinal tract bleeding was contributory in the second patient. Eight patients were lost to follow-up. Of the remaining 30, 13 (35.1%) patients developed catheter-related sepsis. The rate of infection was 1.6 episodes per 100 catheter-days. Thirteen tubes were removed prematurely, 6 (16.2%) due to sepsis, 5 (13.5%) because of tube blockage and 2 (5.4%) because of loculated ascites. The median length of time for which catheters were functional was 37 days (95% CI 14.1-59.6), with an average daily drainage of 539.5 ml (range 18-4000 ml). In conclusion, indwelling peritoneal drainage catheters provide a useful alternative to paracentesis in the management of symptomatic malignant ascites. Although it avoids the need for repeated paracentesis, it is not without risks. We discuss and propose some precautions to be observed in the use of these catheters.
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.
