Support Care Cancer (2008) 16:975–978 DOI 10.1007/s00520-008-0453-x
SHORT COMMUNICATION
Peritoneal catheter for continuous drainage of ascites in advanced cancer patients Sebastiano Mercadante & Giuseppe Intravaia & Patrizia Ferrera & Patrizia Villari & Fabrizio David
Received: 14 January 2008 / Accepted: 3 April 2008 / Published online: 1 May 2008 # Springer-Verlag 2008
Abstract Introduction Advanced cancer patients with refractory ascites do not often respond to dietary sodium restriction and diuretics. While paracentesis is effective, the condition invariably recurs, necessitating repeated procedures. A continuous peritoneal drainage by an indwelling catheter has been reported to be hugely beneficial symptomatically, avoiding the hazards and disadvantages of multiple repeated procedures and direct and indirect costs. Materials and methods Forty patients with advanced cancer patients admitted to an acute pain relief and palliative care unit, who presented symptomatic ascites, were recruited for continuous drainage of peritoneal fluid. A central venous catheter set for Seldinger technique was used. Technical failure was defined as an unsuccessful drainage of fluid through the catheter. Immediate and late complications, including hypotension, haemorrhage, tube blockage, dislodgment and sepsis were recorded. Record of daily drainage during admission were noted. At time of discharge, patients were asked to rate their global symptom burden as improved, unchanged or worsened. The follow-up was performed with frequent phone contacts or day-hospital admission in case of problems. Results The mean patients’ age was 68 years, and 21 were men. Patients were receiving unsuccessfully a mean dose of furosemide of 32 mg/day. The technique was not painful and was easily accepted by patients. Insertion was technically successful in almost all patients. Mean admission time was S. Mercadante (*) : G. Intravaia : P. Ferrera : P. Villari : F. David Pain Relief and Palliative Care Unit, La Maddalena Cancer Center, Via San Lorenzo 312, 90146 Palermo, Italy e-mail:
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5.5 days (range 2–14), and the mean drained volume during admission was 8,499 ml (range 800–20,700), 2,850 ml (300–4,200) being drained on the first 24 h. No immediate complications were recorded. Six patients died during admission. The mean survival was 38.9 days (range 1–120). Of the 34 patients who were discharged home, 22 patients stated that symptom burden had improved, while in 10 patients symptom burden did not change or worsened, probably due to the advanced status of diseases and multiple contributing factors. Five, two, and one patients required skin sutures at 1, 2 and 3 months, respectively. About one third of patients had mechanical problems, some of them requiring a catheter replacement. No infection was recorded. Conclusion In conclusion, a permanent peritoneal catheter was a valuable method to remove abdominal fluids and reduce symptom burden attributable to ascites and was also easy to use at home. Complication rate was acceptable and balanced by the benefits of the technique which avoided frequent paracentesis and associated complications. Keywords Malignant ascites . Paracentesis . Peritoneal drainage . Palliative care
Introduction Ascites is a major complication of ovarian cancer but also presents in other primary tumors. It has been estimated that treatment of ascites accounts for 6% of hospice admissions [7]. Advanced cancer patients with refractory ascites do not often respond to dietary sodium restriction and diuretics, have both loop or distal tubule activity, have poor prognosis, inadequate treatment options, and experience debilitating symptoms including abdominal discomfort, nausea and vomiting, early satiety, shortness of breath and
DO00453; No of Pages
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constipation, severely impairing their residual quality of life. The likelihood of success with diuretics depends on careful patient selection. Hyperaldosteronism is a concomitant of ascites associated with portal hypertension (a trasudate with a relatively low albumin concentration, best indicated by a serum-ascites albumin difference or gradient of >11 g/l), i.e. cirrhosis, hepatocellular cancer, massive hepatic metastases and spironolactone is more likely to be successful [1, 11]. Paracentesis is generally preferable for patients with an exudate with relatively high albumin concentration, best indicated by a serum-ascites albumin gradient of
