Ewha Med J.  2020 Apr;43(2):29-34. 10.12771/emj.2020.43.2.29.

Safety and Effectiveness of Indwelling Percutaneous Drainage in Hospitalized Terminally Ill Cancer Patients with Recurrent Ascites

Affiliations
  • 1Medical Oncology and Hematology
  • 2Departments of Internal Medicine, Family Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
  • 3Departments of Internal Medicine, Radiology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea

Abstract


Objectives
Terminally ill cancer patients in hospice palliative care unit are reluctant to undergo repetitive invasive procedures due to coagulopathies and poor performance or condition, while catheter management such as regular irrigation during hospitalization is easy. The purpose of this study was to investigate the safety and efficacy of indwelling intraperitoneal (IP) catheter in hospitalized terminally ill cancer patients with recurrent ascites.
Methods
A retrospective review was conducted in patients who underwent IP catheter at the hospice palliative care unit of Pusan National University Yangsan Hospital between August 2016 and June 2018. All catheters were inserted by interventional radiologists with radiological guidance. The primary end-points were functional IP catheter maintenance rate, which is catheter maintained with patency for drainage until the intended time.
Results
A total of 25 terminally ill cancer patients underwent IP catheters placements during the study period. All catheters were successfully inserted without major complications, but one patient had trivial bleeding and one other patient had temporary pain. The median time from admission to catheter insertion was 5 days (range, 1 to 49 days). Twenty-one catheters were maintained with function until the intended time, three cases were maintained without function, and the last one was removed early due to obstruction and pain. Finally, the functional IP maintenance rate was 84% (21/25) and the median functional catheter life span was 15 days (95% confidence interval, 10.8 to 17.2).
Conclusion
Our study showed relatively favorable results for IP catheter maintenance and safety in hospitalized terminally ill cancer patients with malignant ascites.

Keyword

Ascites; Malignant; Neoplasms; Catheters; Hospice care

Reference

1. Garrison RN, Kaelin LD, Galloway RH, Heuser LS. 1986; Malignant ascites: clinical and experimental observations. Ann Surg. 203:644–651. DOI: 10.1097/00000658-198606000-00009. PMID: 3718029. PMCID: PMC1251196.
2. Easson AM, Bezjak A, Ross S, Wright JG. 2007; The ability of existing questionnaires to measure symptom change after paracentesis for symptomatic ascites. Ann Surg Oncol. 14:2348–2357. DOI: 10.1245/s10434-007-9370-3. PMID: 17505860.
Article
3. Day R, Mitchell T, Keen A, Perkins P. 2013; The experiences of patients with ascites secondary to cancer: a qualitative study. Palliat Med. 27:739–746. DOI: 10.1177/0269216313480400. PMID: 23558342.
Article
4. Husain A, Bezjak A, Easson A. 2010; Malignant ascites symptom cluster in patients referred for paracentesis. Ann Surg Oncol. 17:461–469. DOI: 10.1245/s10434-009-0774-0. PMID: 19866240.
Article
5. Becker G, Galandi D, Blum HE. 2006; Malignant ascites: systematic review and guideline for treatment. Eur J Cancer. 42:589–597. DOI: 10.1016/j.ejca.2005.11.018. PMID: 16434188.
Article
6. Lee CW, Bociek G, Faught W. 1998; A survey of practice in management of malignant ascites. J Pain Symptom Manage. 16:96–101. DOI: 10.1016/S0885-3924(98)00037-2.
Article
7. Keen A, Fitzgerald D, Bryant A, Dickinson HO. 2010; Management of drainage for malignant ascites in gynaecological cancer. Cochrane Database Syst Rev. CD007794. DOI: 10.1002/14651858.CD007794.pub2. PMID: 20091648. PMCID: PMC4170997.
Article
8. Fleming ND, Alvarez-Secord A, Von Gruenigen V, Miller MJ, Abernethy AP. 2009; Indwelling catheters for the management of refractory malignant ascites: a systematic literature overview and retrospective chart review. J Pain Symptom Manage. 38:341–349. DOI: 10.1016/j.jpainsymman.2008.09.008. PMID: 19328648.
Article
9. Mercadante S, Intravaia G, Ferrera P, Villari P, David F. 2008; Peritoneal catheter for continuous drainage of ascites in advanced cancer patients. Support Care Cancer. 16:975–978. DOI: 10.1007/s00520-008-0453-x. PMID: 18449571.
Article
10. Gu X, Zhang Y, Cheng M, Liu M, Zhang Z, Cheng W. 2016; Management of non-ovarian cancer malignant ascites through indwelling catheter drainage. BMC Palliat Care. 15:44. DOI: 10.1186/s12904-016-0116-5. PMID: 27103467. PMCID: PMC4839130.
Article
11. Lee A, Lau TN, Yeong KY. 2000; Indwelling catheters for the management of malignant ascites. Support Care Cancer. 8:493–499.
12. Stukan M. 2017; Drainage of malignant ascites: patient selection and perspectives. Cancer Manag Res. 9:115–130. DOI: 10.2147/CMAR.S100210. PMID: 28442933. PMCID: PMC5396842.
Article
13. Belfort MA, Stevens PJ, DeHaek K, Soeters R, Krige JE. 1990; A new approach to the management of malignant ascites; a permanently implanted abdominal drain. Eur J Surg Oncol. 16:47–53.
14. Lungren MP, Kim CY, Stewart JK, Smith TP, Miller MJ. 2013; Tunneled peritoneal drainage catheter placement for refractory ascites: single-center experience in 188 patients. J Vasc Interv Radiol. 24:1303–1308. DOI: 10.1016/j.jvir.2013.05.042. PMID: 23876552.
Article
15. Maleux G, Indesteege I, Laenen A, Verslype C, Vergote I, Prenen H. 2016; Tenckhoff tunneled peritoneal catheter placement in the palliative treatment of malignant ascites: technical results and overall clinical outcome. Radiol Oncol. 50:197–203. DOI: 10.1515/raon-2016-0002. PMID: 27247552. PMCID: PMC4852959.
Article
16. Tapping CR, Ling L, Razack A. 2012; PleurX drain use in the management of malignant ascites: safety, complications, long-term patency and factors predictive of success. Br J Radiol. 85:623–628. DOI: 10.1259/bjr/24538524. PMID: 21427184. PMCID: PMC3479885.
Article
17. Richard HM 3rd, Coldwell DM, Boyd-Kranis RL, Murthy R, Van Echo DA. 2001; Pleurx tunneled catheter in the management of malignant ascites. J Vasc Interv Radiol. 12:373–375. DOI: 10.1016/S1051-0443(07)61919-8.
Article
18. Monsky WL, Yoneda KY, MacMillan J, Deutsch LS, Dong P, Hourigan H, et al. 2009; Peritoneal and pleural ports for management of refractory ascites and pleural effusions: assessment of impact on patient quality of life and hospice/home nursing care. J Palliat Med. 12:811–817. DOI: 10.1089/jpm.2009.0061. PMID: 19622018.
Article
19. Coupe NA, Cox K, Clark K, Boyer M, Stockler M. 2013; Outcomes of permanent peritoneal ports for the management of recurrent malignant ascites. J Palliat Med. 16:938–940. DOI: 10.1089/jpm.2012.0535. PMID: 23734592.
Article
20. Ozkan O, Akinci D, Gocmen R, Cil B, Ozmen M, Akhan O. 2007; Percutaneous placement of peritoneal port-catheter in patients with malignant ascites. Cardiovasc Intervent Radiol. 30:232–236. DOI: 10.1007/s00270-005-0252-4. PMID: 17206391.
Article
21. Savin MA, Kirsch MJ, Romano WJ, Wang SK, Arpasi PJ, Mazon CD. 2005; Peritoneal ports for treatment of intractable ascites. J Vasc Interv Radiol. 16:363–368. DOI: 10.1097/01.RVI.0000147082.05392.2B. PMID: 15758132.
Article
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