Therapeutic Procedures for Malignant Ascites in a Palliative Care Outpatient Clinic.

Abstract:

BACKGROUND:The optimal treatment of malignant ascites (MA) and feasibility of the management with free drainage remain unclear. OBJECTIVE:To study the success of drainage, complications, and survival after paracentesis or insertion of an indwelling tunneled catheter (TC) for the MA performed on a day-case basis. DESIGN AND SETTING:We evaluated 118 paracenteses and 48 insertions of TCs performed in 104 patients with MA at the Palliative Care Outpatient Unit of Tampere University Hospital. RESULTS:Drainage of ascites fluid (median 3700 mL; range 300-13,200 mL) was successful in all cases. The complication rates were 7% and 25% for paracenteses and TCs, respectively. Most of the complications were minor. Repeated procedures were needed in 64% and 10% of the paracenteses and insertions of TCs, respectively, (p < 0.001). Median survival after the first procedure was 40 days (interquartile range, IQR: 17-115). Patients with pancreatic cancer had shorter median survival (19 days; IQR: 9-35) compared with other patients (47 days; IQR: 23-143) (age-adjusted HR 2.73; 95% CI: 1.65-4.52), whereas patients receiving chemotherapy had longer median survival (112 days; IQR: 43-205) compared with patients without chemotherapy (25 days; IQR: 14-52) (age-adjusted HR 2.48; 95% CI: 1.58-3.89). The volume of removed ascites fluid was not associated with survival. CONCLUSIONS:Free drainage of MA seems feasible in an outpatient clinic. Early insertion of TC should be considered to avoid repeated paracenteses. However, in patients with pancreatic cancer, paracentesis might be an accepted alternative due to their short life expectancy.

journal_name

J Palliat Med

authors

Korpi S,Salminen VV,Piili RP,Paunu N,Luukkaala T,Lehto JT

doi

10.1089/jpm.2017.0616

subject

Has Abstract

pub_date

2018-06-01 00:00:00

pages

836-841

issue

6

eissn

1096-6218

issn

1557-7740

journal_volume

21

pub_type

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